应用MSK试剂盒-质谱法直接鉴定阳性血培养标本  

Direct identification of positive blood culture specimens by MSK-MS method

作　　者：李媛睿[1] 俞静[1] 刘婧娴[1] 陈峰[1] 皇甫昱婵[1] 陶晓勤[1] 刘瑛[1] 

机构地区：[1]上海交通大学医学院附属新华医院检验科微生物实验室,上海200092

出　　处：《上海交通大学学报（医学版）》2016年第2期256-263,共8页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的评估应用MALDI Sepsityper^(TM)Kit与MicroflexTMLT型基质辅助激光解析电离飞行时间质谱仪(MSK试剂盒-质谱法)直接鉴定阳性血培养标本中微生物的可行性与临床价值。方法 2014年3—8月,应用MSK试剂盒-质谱法和传统血培养鉴定法对上海交通大学医学院附属新华医院临床阳性血培养标本中微生物进行鉴定。若两者鉴定结果不符,则用基因测序法予以确认。结果 491例阳性血培养标本中,462例为单种菌,29例为复数菌,共包括30个属和64个种。应用MSK试剂盒-质谱法直接鉴定血培养标本中单种菌的种、属水平符合率分别为72.5%(335/462)、76.0%(351/462)。其中革兰阴性菌的种、属水平符合率分别为75.4%(132/175)、77.7%(136/175);革兰阳性菌的种、属水平符合率分别为70.9%(178/251)、74.9%(188/251);念珠菌的种、属水平符合率均为75.0%(27/36)。复数菌血培养标本中鉴定出1种、2种细菌的种水平符合率分别为55.2%(16/29)、20.7%(6/29)。应用MSK试剂盒-质谱法直接鉴定血流感染中临床常见菌的属水平符合率达74.2%~96.9%,鉴定时间仅需40 min/样本。结论应用MSK试剂盒-质谱法能准确和快速地鉴定血流感染常见菌,从而缩短血流感染诊断时间,为临床上快速、合理选用抗生素提供依据。Objective To evaluate the feasibility and clinical significance of applying MALDI Sepsityper Kit and Microflex LT matrix-assisted laser desorption/ionization time-of-flight mass spectrometry（MSK-MS method） to direct identification of microorganisms in positive blood culture specimens.Methods From March to August 2014,both MSK-MS method and traditional blood culture identification method were adopted to identify microorganisms in positive blood culture specimens collected in Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine.If identified results of two methods were inconsistent,the gene sequencing was adopted to make confirmation.Results Among 491 positive blood culture specimens,462 of them were monobacterial specimens and 29 of them were polymicrobial specimens.There were a total of 30 genera and 64 species or groups.For monobacterial specimens,the coincidence rates of MSK-MS method for identifying genera and species were 72.5%（335/462） and 76.0%（351/462）,respectively.The coincidence rates of MSK-MS method for identifying genera and species of Grarrmegative bacteria,Gram-positive bacteria,and Candida were 75.4%（132/175） and 77.7%（136/175）,70.9%（178/251） and 74.9%（188/251）,and75.0%（27/36） and 75.0%（27/36）,respectively.For polymicrobial specimens,the coincidence rates for identifying one and two bacteria were 55.2%（16/29） and 20.7%（6/29）,respectively.The coincidence rates of MSK-MS method for identifying genera of common clinical bacteria of the bloodstream infection were between74.2%and 96.9%.The identification time was only 40 min per specimen.Conclusion MSK-MS method can accurately and rapidly identify common bacteria of the bloodstream infection,so as to shorten the time for diagnosing the bloodstream infection and provide evidences for quick and rational use of antibiotics.

关 键 词：MALDI Sepsityper 基质辅助激光解析电离飞行时间质谱仪 血培养 微生物 

分 类 号：R446.5[医药卫生—诊断学]