基质辅助激光解吸电离飞行时间质谱结合血清分离胶促凝管法及比浊仪直接鉴定无菌体液病原菌的应用  

Application of MALDI-TOF MS combined with serum separator tube and turbidimetry for direct identification of pathogens in sterile body fluids

作　　者：张肖 蔡辉 ZHANG Xiao;CAI Hui(Department of Laboratory Medicine,Ninth Hospital of Suzhou,Suzhou Jiangsu 215200,China)

机构地区：[1]江苏省苏州市第九人民医院检验科,江苏苏州215200 [2]江苏盛泽医院检验科

出　　处：《中国感染与化疗杂志》2025年第2期168-173,共6页Chinese Journal of Infection and Chemotherapy

基　　金：苏州市医院协会感染管理专项研究课题(SZSYYXH-2023-ZD10)。

摘　　要：目的 探讨基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)联合血清分离胶促凝管法及比浊仪直接鉴定无菌体液病原菌的应用。方法 收集2023年1-12月苏州市第九人民医院检验科血培养仪报警时间<48 h、单一病原菌感染的无菌体液阳性标本(血液、胸腹水、胆汁、脑脊液)共284份。所有标本均通过比浊仪进行菌液浓度检测,利用MALDI-TOF MS技术,根据病原菌浓度对应的分值快速评估鉴定结果的可靠性。结果 使用MALDI-TOF MS进行菌种鉴定时,各菌种可信结果的最低菌液浓度如下:大肠埃希菌3.0 mcf(1 mcf=3×10^(8) CFU/mL),肺炎克雷伯菌2.0 mcf,金黄色葡萄球菌3.0 mcf,粪肠球菌3.5 mcf,念珠菌3.5 mcf。VITEK 2 鉴定、常规MALDI-TOF MS 鉴定与MALDI-TOF MS直接鉴定进行对比:常规MALDI-TOF MS鉴定与VITEK 鉴定结果一致的有282份;MALDI-TOF MS直接鉴定>1.7的有272份,灵敏度为95.8% (272/284)。三种鉴定法得到的鉴定结果差异无统计学意义(χ^(2)=2.09,P=0.55)。结论 MALDI-TOF MS技术联合血清分离胶促凝管法及比浊仪直接鉴定无菌体液病原菌,是病原菌鉴定的可靠创新技术,优点为快速准确,为临床尽快提供病原学的检出依据,具有重要的临床价值。Objective To investigate the application of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF MS)combined with serum separator tube and turbidimetry in the direct identification of pathogens in sterile body fluids.Methods A total of 284 positive sterile body fluid specimens(blood,hydrothorax,ascites,bile,and cerebrospinal fluid)infected by a single pathogen with a blood culture instrument alarm time less than 48 h were collected from January to December 2023 in the Department of Laboratory Medicine at Suzhou Ninth People’s Hospital.All the specimens were tested by turbidimeter for pathogen concentration.And the reliability of the identification results was judged by MALDI-TOF MS scores according to different concentrations of the main pathogens.Results The lowest concentration of microorganism for achieving reliable results was 3.0 mcf for Escherichia coli,2.0 mcf for Klebsiella pneumoniae,3.0 mcf for Staphylococcus aureus,3.5 mcf for Enterococcus faecalis and 4.0 mcf for Candida when identified by MALDI-TOF MS.The results were compared between VITEK 2 identification,routine MALDI-TOF MS identification,and direct MALDI-TOF MS identification.The results of routine MALDI-TOF MS identification and VITEK identification were consistent in 282 cases.The concentration greater than 1.7 was found in 272 cases with direct MALDI-TOF MS,and the sensitivity of MALDI-TOF MS was 95.8%(272/284).The results did not show significant difference between the 3 identification 2 methods(χ=2.09,P=0.55).Conclusions MALDI-TOF MS combined with serum separator tube and turbidimetry is a reliable and innovative technique for identifying pathogens in sterile body fluids.It is rapid and accurate,and may be valuable for early etiological diagnosis in clinical practice.

关 键 词：比浊法 基质辅助激光解吸电离飞行时间质谱 快速鉴定 无菌体液 病原菌 

分 类 号：R446[医药卫生—诊断学]