显色培养基联合简单生化试验鉴定常见氧化酶阴性革兰阴性杆菌的能力验证  

Evaluation on the capability of CHROMagar orientation medium combined with simple biochemical tests for identfficaction of common oxidase.negtive gram-negative bacilli

作　　者：赵声远[1] 陈奕雯[3] 李林徽[1] 萧晨路[1] 李洁[1] 糜琛蓉 韩立中[1] 倪语星[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院临床微生物科,200025 [2]医院感染管理科 [3]武汉市中医医院检验科,430010

出　　处：《中华微生物学和免疫学杂志》2013年第7期525-530,共6页Chinese Journal of Microbiology and Immunology

摘　　要：目的对显色培养基联合简单生化反应鉴定常见氧化酶阴性革兰阴性杆菌的方案进行能力验证。方法以VITEK 2 Compact全自动微生物分析系统鉴定细菌作为参考方法，计算联合应用科玛嘉定位显色培养基、吲哚试验、鸟氨酸脱羧酶试验、赖氨酸脱羧酶试验鉴定临床标本中常见氧化酶阴性革兰阴性杆菌的敏感度、特异性、似然比、约登指数、Kappa值等参数并进行McNemar检验，分析这一方案的真实性、与参考方法的一致性并比较经济成本。结果通过对8个属10个种共318株氧化酶阴性革兰阴性杆菌鉴定结果的分析表明，黏质沙雷菌、嗜麦芽窄食单胞菌、鲍曼不动杆菌的敏感度和特异性均为100％，大肠埃希菌、产气肠杆菌、肺炎克雷伯杆菌的敏感度和特异性均大于90％，阴沟肠杆菌、产酸克雷伯杆菌、弗劳地枸橼酸杆菌和奇异变形杆菌的特异性均大于90％，但灵敏度为75％～90％；除了弗劳地枸橼酸杆菌的Kappa值为0．5947外，其余均大于0．85；McNemar检验P值均大于0．05；本研究方案成本只有参考方法的10％。结论显色培养基联合简单生化试验可快速经济有效地鉴定数种常见氧化酶阴性革兰阴性杆菌。Objective To evaluate the practicability of CHROMagar orientation medium combined with simple biochemical tests for identification of common oxidase-negtive gram-negative bacilli. Methods The CHROMagar orientation medium was used together with biochemical tests including indole test, ornithine decarboxylase test and lysine decarboxylase test for identification of common oxidase-negtive gram-negative bacilli. The sensitivity, specificity, likelihood ratio, Youden index and Kappa value of the diagnostic assays were evaluated. McNemar test was performed to evaluate facticity, accuracy and cost of the method in com- parison with the Vitek-2 system as reference method. Results The identification of oxidase-negtive gram- negative bacilli from 318 bacterial strains showed that the sensitivities and specificities of CHROMagar orien- tation mediumm in combination with simple biochemical tests to Serratia marcesceus, Stenotrophomonas mal- tophilia and Acinetobacter baumannii reached 100% , and for Escherichia coli, Enterobacter aerogenes and Klebsiella pneumoiae were above 90%. The specificities for identification of Enterobacter cloacae, Klebsiella oxytoca, Citrobacterfreundii and Proteus mirabilis were all above 90% , but the sensitivities were around 75% -90%. Kappa values of the assays were above 0.85, howerer, which was only 0. 5947 for Citrobacter freundii. McNemar test showed that all P values were above 0.05, and cost of the assays was reduced by 90%. Conclusion CHROMagar orientation medium in combination with simple biochemical tests is a cost- effective assay for identification of common oxidase-negtive gram-negative bacilli.

关 键 词：显色培养基 生化试验 革兰阴性杆菌 细菌鉴定 能力验证 

分 类 号：R446[医药卫生—诊断学]