MALDI-TOF MS与VITEK2在血流感染致病菌快速鉴定及药敏试验中的应用  

Application of MALDI-TOF MS and VITEK2 in rapid identification pathogenic bacteria in blood infection and drug susceptibility test

作　　者：邓文 余静贵 李洁群 赵娜 王玮 胡凯 DENG Wen;YU Jing-gui;LI Jie-qun;ZHAO Na;WANG Wei;HU Kai(Clinical Laboratory,The Second People's Hospital of Jingdezhen,Key Laboratory of Jingdezhen for Cellular and Molecular Medicine,Jingdezhen,Jiangxi 333000)

机构地区：[1]景德镇市第二人民医院检验科景德镇市细胞与分子医学重点实验室,江西景德镇333000

出　　处：《赣南医学院学报》2024年第4期383-391,共9页JOURNAL OF GANNAN MEDICAL UNIVERSITY

基　　金：江西省卫生健康委员会科技计划项目(202212055)。

摘　　要：目的:探究基质辅助激光解吸/电离飞行时间质谱(Matrix-assisted laser desorption/ionizationtime-of-flight mass spectrometry,MALDI-TOF MS)与VITEK2在血流感染致病菌药敏试验中的联合应用效果。方法:选取景德镇市第二人民医院检验科2022年1月1日至2022年12月31日血流感染阳性样本126份,分别行常规鉴定及MALDI-TOF MS鉴定,完成菌株鉴定后通过VITEK2系统行抗菌药物敏感性试验(Antimicrobial susceptibility testing,AST),比较2种鉴定方法的细菌菌株鉴定结果及细菌耐药情况。结果:常规鉴定方法对革兰氏阴性、革兰氏阳性菌在属、种水平鉴定符合率达到100%;MALDI-TOF MS鉴定革兰氏阴性菌在属水平的符合率达97.7%(85/87),在种水平的符合率达95.4%(83/87),2例无结果(1例阴沟肠杆菌阴沟亚种,1例少动鞘氨醇单胞菌);MALDI-TOF MS鉴定革兰氏阳性菌在属、种水平的符合率均达97.4%(38/39),1例无结果(科氏葡萄球菌解脲亚种)。常规鉴定+VITEK2对革兰氏阴性菌AST分析的分类一致(Categorical agreement,CA)、基本一致(Essential agreement,EA)分别达到98.6%(1086/1101)、99.5%(1096/1101),对革兰氏阳性菌AST分析的CA、EA分别达到98.6%(550/558)、99.6%(556/558);MALDI-TOF MS+VITEK2(VITEK MS)对革兰氏阴性菌AST分析的CA、EA分别达到98.3%(1082/1101)、99.5%(1095/1101),对革兰氏阳性菌AST分析的CA、EA分别达到97.8%(546/558)、99.5%(555/558)。进一步参考肉汤稀释法药敏结果行一致性分析。结果发现,常规鉴定+VITEK2在革兰氏阴性菌的药敏试验中,10份AST鉴定结果出现小误差(Minus errors,MIE),5份AST鉴定结果出现重大误差(Major errors,ME);在革兰氏阳性菌的药敏试验中,8份AST鉴定结果出现MIE,2份AST鉴定结果出现ME。VITEK MS在革兰氏阳性菌的药敏试验中,13份AST鉴定结果出现MIE,6份AST鉴定结果出现ME;在革兰氏阳性菌的药敏试验中,9份AST鉴定结果出现MIE,3份AST鉴定结果出现ME。结论:MALDI-TOF MS联合VITEK2�Objective:To investigate the effect of matrix-assisted laser desorption/ionizationtime-of-flight mass spectrometry(MALDI-TOF MS)combined with VITEK2 in the drug susceptibility test of pathogenic bacteria of bloodstream infection.Methods:During the period spanning January 1,2022,to December 31,2022,126 blood stream infection positive samples were obtained from the microbiology repository of the Second People's Hospital of Jingdezhen.These samples underwent microbial identification using both conventional methods and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry(MALDI-TOF MS).Subsequently,Antimicrobial Susceptibility Testing(AST)was carried out utilizing the VITEK2 system.A comparative analysis was then conducted to evaluate the concordance between bacterial strain identification outcomes and antimicrobial resistance patterns obtained from the two aforementioned identification methodologies.Results:The conventional identification methods achieved a perfect accuracy of 100%in discriminating Gram-negative and Gram-positive bacteria at both genus and species levels,with zero instances of inconclusive results or misidentifications.MALDI-TOF MS demonstrated an accuracy of 97.7%(85/87)at the genus level and 95.4%(83/87)at the species level for Gram-negative bacteria,with only two cases resulting in inconclusive outcomes(1 case enterobactercloacaesubsp.cloacae;1 case sphingomonas paucimobilis).Similarly,for Gram-positive bacteria,MALDI-TOF MS attained an accuracy of 97.4%(38/39)at both taxonomic levels,with only one inconclusive result(S.Coriolis urealyticum subsp).Conventional methods and VITEK2 in categorical agreement(CA)and essential agreement(EA)for gram-negative in AST reached 98.6%(1086/1101)and 99.5%(1096/1101)respectively;CA and EA for gram-positive in AST reached 98.6%(550/558)and 99.6%(556/558)respectively.MALDI-TOF MS+VITEK2(VITEK MS)in CA and EA for gram-negative in AST reached 98.3%(1082/1101)and 99.5%(1095/1101)respectively;CA and EA for gram-positive in AST reached 97.8%(546/

关 键 词：基质辅助激光解吸/电离飞行时间质谱 血流感染 抗菌药物敏感性试验 

分 类 号：R446.1[医药卫生—诊断学]