基质辅助激光解吸电离-飞行时间质谱结合流程整改在儿童血培养阳性患者抗菌治疗中的应用  

Application of MALDI-TOF MS combined with process rectification in antibacterial therapy for children with positive blood culture

作　　者：许春燕[1] 郭锋[2] 钱娇[1] 余素飞[1] XU Chun-yan;GUO Feng;QIAN Jiao;YU Su-fei(Clinical Laboratory,Taizhou Hospital,Taizhou,Zhejiang 317000,China;不详)

机构地区：[1]浙江省台州医院检验科,浙江台州317000 [2]浙江省台州医院质量改进部,浙江台州317000

出　　处：《中国卫生检验杂志》2020年第21期2589-2591,2594,共4页Chinese Journal of Health Laboratory Technology

基　　金：浙江省恩泽医疗(集团)中心2019年B类(19EZB14)。

摘　　要：目的评估使用基质辅助激光解吸电离-飞行时间质谱(MALDI-TOF MS)结合流程整改与传统方法比对儿童血培养阳性患者预后影响。方法将研究对象分2组:干预前组(2017年4月1日-2018年3月31日)按传统流程,孵育18 h^24 h后进行VITEK 2 Compact鉴定与药敏;干预后组(2018年4月1日-2019年3月31日)转种涂片等同干预前,但孵育6 h^8 h后,下午4点进行MS鉴定,将细菌名再初报临床;同时做药敏试验,第二天报告。结果共纳入262例患者,干预前组120例,干预后组142例。干预后组可显著减少最适当抗微生物治疗施用所用的时间、微生物报告时间、平均抗生素费用、患者住院时间、抗生素治疗时间(P<0.05)。但2组相同细菌菌血症复发差异无统计学意义(P>0.05)。结论MALDI-TOF MS结合流程整改可降低微生物检测报告时间,减少患者抗生素治疗时间及住院时间,减少患者相关费用。Objective To evaluate the prognostic impact of matrix-assisted laser desorption ionization-time of flight mass spectrometry(MALDI-TOF MS)combined with flow rectification and traditional methods in children with positive blood culture.Methods The subjects were divided into two groups:pre-intervention group during April 1,2017-March 31,2018 according to the traditional procedure,VITEK 2 Compact identification and drug sensitivity were performed after 18 h-24 h incubation;in post-intervention group during April 1,2018-March 31,2019,the smear was equivalent to the intervention before the intervention,but after 6 h-8 h of incubation,the MS identification was performed at 4 pm,and the bacterial name was first reported to the clinic;the susceptibility test was performed at the same time,and the next day was reported.Results A total of 262 patients were enrolled,with 120 cases in the pre-intervention group and 142 cases in the post-intervention group.After intervention,the time taken to administer the most appropriate antimicrobial therapy,microbial reporting time,average antibiotic cost,hospital stay,and antibiotic treatment time were significantly reduced in the intervention group(P<0.05).However,there was no statistical significance on the recurrence of the same bacterial bacteremia in both groups(P>0.05).Conclusion MALDI-TOF MS combined with process rectification can reduce the time of microbial detection,reduce the time of antibiotic treatment,hospitalization time and reduce the related costs.

关 键 词：基质辅助激光解吸电离-飞行时间质谱 流程整改 儿童 血培养阳性 

分 类 号：R446.5[医药卫生—诊断学]