血培养阳性样本快速菌种鉴定和药物敏感性分析  

Rapid bacterial identification and drug susceptibility test of blood culture-positive samples

作　　者：李安琪 张澍雅 何珊娜 陈巧巧[1] 吕绮 吕婉飞[1] 李春仙 王卫华[1] 郑琳[1] LI Anqi;ZHANG Shuya;HE Shanna;CHEN Qiaoqiao;LÜQi;LÜWanfei;LI Chunxian;WANG Weihua;ZHENG Lin(Department of Clinical Laboratory,the First Affiliated Hospital of Ningbo University,Ningbo 315000,Zhejiang,China)

机构地区：[1]宁波大学附属第一医院检验科,浙江宁波315000

出　　处：《检验医学》2024年第3期243-248,共6页Laboratory Medicine

摘　　要：目的分析分离胶离心富集和5 h培养2种前处理方法在血培养阳性样本快速菌种鉴定和快速药物敏感性分析中的临床应用价值。方法收集2021年10月—2022年10月宁波大学附属第一医院报阳的血培养样本211例,分别采用分离胶离心富集和5 h培养(快速方法),以及12 h培养(标准方法)3种方法进行前处理。采用基质辅助激光解吸电离飞行时间质谱(MALDI-TOF-MS,简称MS)对3种方法处理的血培养阳性样本进行快速菌种鉴定。采用自动化鉴定药敏仪对156例需氧瓶报阳血培养样本进行药物敏感性试验。以常规培养(18~24 h)+MS鉴定结果为标准,比较5 h培养+MS和分离胶离心富集+MS 2种快速方法菌株鉴定准确率。以培养24 h后仪器法药物敏感性试验结果为标准,判断5 h培养和分离胶离心富集后仪器法药物敏感性试验结果与标准方法的一致率。结果2种快速方法鉴定准确率最高的菌种为粪肠球菌,分别为100.00%、87.50%;5 h培养+MS对链球菌属的鉴定准确率较低(33.33%)。2种快速方法对肠杆菌科和非发酵菌的药物敏感性分析结果与标准培养+MS的药物敏感性分析结果一致性分别超过73.00%和85.00%;对葡萄球菌属和肠球菌属部分抗菌药物的药物敏感性分析结果一致性达100.00%;对万古霉素的药物敏感性分析结果一致性最低,为70.73%。结论5 h培养+MS和分离胶离心富集+MS可快速判断血培养阳性样本病原菌种类及其耐药性,准确率较高,适合在临床微生物实验室推广。Objective To analyze the clinical roles of rapid bacterial identification and drug susceptibility test of blood culture-positive samples by centrifuge enrichment method and 5 h culture method combined with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF-MS).Methods Totally,211 blood culture-positive samples at the First Affiliated Hospital of Ningbo University from October 2021 to October 2022 were collected.The pretreatment was performed by centrifuge enrichment method and 5 h culture method(rapid method)and 12 h culture method(standard method),respectively.MALDI-TOF-MS was used for rapid isolate identification of blood culture-positive samples treated by the 3 methods.The drug susceptibility test of 156 blood culture-positive samples from aerobic bottle was carried out by automatic microbiological identification drug susceptibility instrument.According to the identification results of conventional culture(18-24 h)+MS,the identification accuracy of 2 rapid methods of 5 h culture method+MS and centrifuge enrichment method+MS were compared.According to the identification results of 24 h,the consistency of the results of drug susceptibility test between standard method after 5 h culture method,centrifuge enrichment was evaluated.Results The identification accuracy of Enterococcus faecalis was the highest,and the identification accuracies were 100.00%and 87.50%,respectively.The identification accuracy of Streptococcus was low(33.33%)after 5 h culture method+MS.The drug susceptibility test results of the 2 methods for Enterobacteriaceae and non-fermentative bacteria were more than 73.00%and 85.00%,respectively,compared with the results of standard method.The results of drug susceptibility test for Staphylococcus and Enterococcus were consistent(100.00%).The consistency of vancomycin sensitivity analysis was the lowest(70.73%).Conclusions The 5 h culture method+MS and centrifuge enrichment method+MS can rapidly identify the isolate and drug resistance of pathogenic bacteria in bl

关 键 词：血培养 病原菌鉴定 基质辅助激光解吸电离飞行时间质谱 短时培养法 

分 类 号：R446.5[医药卫生—诊断学]