SDS和SAP前处理联合MALDI-TOF MS在报阳血培养样本快速病原菌鉴定中的价值  

MALDI-TOF MS combined with SDS and SAP pretreatment for rapid identification of positive blood culture

作　　者：余佳佳[1] 李媛睿[1] 刘瑛[1] YU Jiajia;LI Yuanrui;LIU Ying(Department of Clinical Laboratory,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院检验科,上海200092

出　　处：《检验医学》2021年第8期864-868,共5页Laboratory Medicine

基　　金：深圳市医疗卫生三名工程(SZSM201601062)。

摘　　要：目的评估十二烷基硫酸钠(SDS)和皂甙(SAP)前处理联合基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)对报阳血培养样本进行快速病原菌鉴定的应用价值。方法收集2018年4月—2019年4月上海交通大学医学院附属新华医院阳性血培养样本296例,分别采用SDS和SAP对阳性血培养样本进行前处理,获取菌体沉淀后,采用MALDI-TOF MS进行检测,以传统血培养转种培养的鉴定结果为金标准,比较2种前处理方法的病原菌鉴定准确率。结果272例分离出单数菌的阳性血培养样本中,采用SDS和SAP前处理联合MALDI-TOF MS鉴定至种水平的准确率分别为77.2%和70.6%,差异无统计学意义(P=0.079);鉴定到属水平的准确率分别为83.1%和75.7%,差异有统计学意义(P=0.034)。24例分离出2种或2种以上病原菌的血培养样本中,采用SDS和SAP前处理联合MALDI-TOF MS鉴定其中1种细菌至种水平的准确率分别为62.5%和58.3%,差异无统计学意义(P=0.551)。结论SDS和SAP前处理联合MALDI-TOF MS对阳性血培养样本进行鉴定的准确率均较高,可以快速、准确地向临床报告引起血流感染的病原菌种类,可为临床经验抗感染治疗提供参考。SDS作为细胞裂解剂效果略优于SAP。Objective To evaluate the role of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF MS)combined with sodium dodecyl sulfate(SDS)and saponin(SAP)pretreatment for rapid identification of positive blood culture.Methods A total of 296 positive blood cultures were collected in Xinhua Hospital,Shanghai Jiao Tong University School of Medicine from April 2018 to April 2019.The positive blood cultures were pretreated with SDS and SAP,and the pellets of bacteria were acquired and determined by MALDI-TOF MS.The traditional identification of inoculated culture from positive blood cultures were regarded as golden standard.The identification accuracies of the 2 methods were compared and analyzed.Results The identification accuracies of 272 positive monomicrobial blood cultures using MALDI-TOF MS combined with SDS and SAP pretreatment were 77.2%and 70.6%for species level,respectively(P=0.079).The identification accuracies were 83.1%and 75.7%for genus level,respectively(P=0.034).The identification accuracies of 24 positive polymicrobial blood cultures using MALDI-TOF MS combined with SDS and SAP pretreatment were 62.5%and 58.3%for 1 species of bacteria which was identified to species level,respectively(P=0.551).Conclusions The high identification accuracy of MALDI-TOF MS combined with SDS and SAP pretreatment can help us with reporting the bacterium species that cause bloodstream infection to clinicians rapidly and accurately and provide a reference for clinical empirical anti-infection treatment.SDS is slightly better than SAP as a cell lysis agent.

关 键 词：十二烷基硫酸钠 皂甙 基质辅助激光解吸电离飞行时间质谱 血培养 病原菌 快速鉴定 

分 类 号：R446.1[医药卫生—诊断学]