丁毅伟,孙希萌.基于激光散射技术的血流感染革兰阳性球菌快速检测的准确性分析[J].转化医学杂志,2021,10(5):324-329
基于激光散射技术的血流感染革兰阳性球菌快速检测的准确性分析
Evaluation of rapid detection of Gram-positive cocci in bloodstream infection based on laser scattering technique
  
DOI:
中文关键词:  血流感染  激光散射技术  直接快速鉴定  直接快速药敏试验
英文关键词:Bloodstream infection  Laser scattering technology  Direct rapid identification  Direct rapid drug sensitivity
基金项目:解放军总医院第六医学中心创新培育基金(CXPY201915)
作者单位
丁毅伟 首都医科大学基础医学院病原微生物学系解放军总医院第六医学中心呼吸与危重症医学科 
孙希萌 首都医科大学基础医学院病原微生物学系 
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中文摘要:
      目的 评估一种新的快速检测血流感染革兰阳性球菌的方法,并评价其鉴定和药敏的准确性。方法 收集中国人民解放军总医院第六医学中心门诊及住院患者141例革兰阳性球菌血培养阳性样本,应用激光散射技术联合基质辅助激光解吸/电离飞行时间质谱(matrix assisted laser desorption ionization time of flight mass spectrometry,MALDI-TOF MS)对其进行快速直接鉴定,同时联合VITEK 2 Compact微生物仪进行直接快速药敏试验(简称快速直接法),并与常规方法比较,对快速直接法的鉴定率、药敏的分类一致性(categorical agreement, CA)和错误率进行分析。结果 快速直接法对革兰阳性球菌鉴定率为93.6%,其中葡萄球菌属91.8%,肠球菌属94.1%,链球菌属100.0%。金黄色葡萄球菌无错误,凝固酶阴性葡萄球菌在一般错误(minor errors, MIE)中3例、严重错误(major errors, ME)中5例和极严重错误(very major error,VME) 中2例;屎肠球菌在MIE中3例,粪肠球菌在MIE中1例。在85株葡萄球菌中,快速直接法检测头孢西丁阴性一致率为100%(16/16),阳性一致率为97.1%(67/69),总体一致率为97.6%(83/85);检测诱导克林霉素耐药阴性一致率为92.2%(47/51),阳性一致率为94.1%(32/34),总体一致率为92.9%(79/85)。结论 基于激光散射技术联合MALDI-TOF MS和VITEK 2 Compact,能够快速准确得到鉴定和药敏结果,有助于血流感染快速诊断。
英文摘要:
      Objective To evaluate a new method for rapid detection of gram-positive cocci in bloodstream infection, and to evaluate the accuracy of its identification and drug sensitivity. Methods 141 gram-positive cocci blood samples were collected from outpatient and inpatient patients in the Sixth Medical Center of the PLA General Hospital. Application of matrix assisted laser desorption time of flight mass spectrometry Maldi-tof MS), and combined with VITEK 2 Compact, the rapid and direct drug susceptibility test (referred to as the rapid and direct method) was performed, and compared with the conventional method. The identification rate, Categorical agreement (CA) and error rate of rapid and direct method were analyzed. Results The identification rate of Gram-positive cocci by the rapid and direct method was 93.6%, including 91.8% in Staphylococcus, 94.1% in enterococcus and 100.0% in Streptococcus. Staphylococcus aureus had no error rate, and coagulase negative staphylococcus aureus had 3 minor errors (MIE), 5 major errors (ME) and 2 very major errors (VME). There were 3 cases of Enterococcus faecium and 1 case of Enterococcus faecalis in MIE. Among 85 strains of Staphylococcus, the negative and positive rates of cefoxitin were 100% (16/16), 97.1%(67/69), and the overall rate was 97.6% (83/85). The negative and positive rates were 92.2% (47/51), 94.1%(32/34), and the overall rate was 92.9% (79/85). Conclusion The laser scattering technique combined with MALDI-Tof MS and VITEK 2 Compact can quickly and accurately identify and obtain drug sensitivity results, which is helpful for rapid diagnosis of bloodstream infection.
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