Rapid Identification and Multiple Susceptibility Testing of Pathogens from Positive-Culture Sterile Body Fluids by a Combined MALDI-TOF Mass Spectrometry and Vitek Susceptibility System.
Rapid Identification and Multiple Susceptibility Testing of Pathogens from Positive-Culture Sterile Body Fluids by a Combined MALDI-TOF Mass Spectrometry and Vitek Susceptibility System.
复制标题
通过组合 MALDI-TOF 质谱和 Vitek 药敏系统对阳性培养无菌体液中的病原体进行快速鉴定和多重药敏测试。
DOI：
10.3389/fmicb.2016.00523
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发表时间：
2016
影响因子：
5.2
通讯作者：
Li M
中科院分区：
文献类型：
--
作者：
Tian Y;Zheng B;Wang B;Lin Y;Li M
血流、中枢神经系统、腹膜、关节和其他无菌区域的感染与高发病率和后遗症风险相关。及时开始有效的抗菌治疗对改善患者预后至关重要。然而，标准的最终鉴定和抗菌药物敏感性试验（AST）在阳性警报后16-48小时报告。为了快速、有效和低成本的诊断，我们将基质辅助激光解吸/电离飞行时间质谱与Vitek AST系统相结合，并对从中国上海一家医院收集的非重复阳性体液培养物进行快速微生物鉴定（RMI）和快速多重AST（RMAST）。将无菌体液阳性培养物和革兰氏阴性菌（GN）或多种微生物引起的血液阳性培养物直接用于MALDI-TOF测量。对革兰氏阳性菌或酵母菌血培养阳性者，分别用1 ml脑心浸液重悬2 h或4 h。不考虑富集，RMI（每个样品在40分钟内完成）准确地鉴定了GN和GP细菌（分别为98.9%和87.2%），真菌（75.7%）和厌氧菌（94.7%）。分别在81.2%和100%的情况下正确鉴定了多种培养物中的优势种属和未能在工艺路线板上生长的细菌。在存在各种抗生素的情况下确定的RMAST结果的类别一致性与先前的研究相似。RMI和RMAST结果不仅将患者报告的周转时间缩短了18-36小时，而且还表明患者的抗生素治疗是否应该加速，停止或降级，并调整基本药物的修改以优化治疗。
Infections of the bloodstream, central nervous system, peritoneum, joints, and other sterile areas are associated with high morbidity and sequelae risk. Timely initiation of effective antimicrobial therapy is crucial to improving patient prognosis. However, standard final identification and antimicrobial susceptibility tests (ASTs) are reported 16–48 h after a positive alert. For a rapid, effective and low-cost diagnosis, we combined matrix-assisted laser desorption/ionization time of flight mass spectrometry with a Vitek AST system, and performed rapid microbial identification (RMI) and rapid multiple AST (RMAST) on non-duplicated positive body fluid cultures collected from a hospital in Shanghai, China. Sterile body fluid positive culture and blood positive culture caused by Gram negative (GN) or polymicrobial were applied to the MALDI–TOF measurement directly. When positive blood culture caused by Gram positive (GP) bacteria or yeasts, they were resuspended in 1 ml brain heart infusion for 2 or 4 h enrichment, respectively. Regardless of enrichment, the RMI (completed in 40 min per sample) accurately identified GN and GP bacteria (98.9 and 87.2%, respectively), fungi (75.7%), and anaerobes (94.7%). Dominant species in multiple cultures and bacteria that failed to grow on the routing plates were correctly identified in 81.2 and 100% of cases, respectively. The category agreements of RMAST results, determined in the presence of various antibiotics, were similarly to previous studies. The RMI and RMAST results not only reduce the turnaround time of the patient report by 18–36 h, but also indicate whether a patient's antibiotic treatment should be accelerated, ceased or de-escalated, and adjusted the essential drugs modification for an optimized therapy.