Gram-stain plus MALDI-TOF MS (Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry) for a rapid diagnosis of urinary tract infection.
Gram-stain plus MALDI-TOF MS (Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry) for a rapid diagnosis of urinary tract infection.
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DOI：
10.1371/journal.pone.0086915
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Bouza E
中科院分区：
文献类型：
--
作者：
Burillo A;Rodríguez-Sánchez B;Ramiro A;Cercenado E;Rodríguez-Créixems M;Bouza E
尿路感染 (UTI) 的微生物学确认需要 24-48 小时。与此同时，患者通常会接受经验性抗生素治疗，有时是不适当的。我们评估了对尿液样本依次进行革兰氏染色和 MALDI-TOF MS 质谱 (MS) 的可行性，以预测临床有用的信息。 2012年5月至6月，我们随机抽取了疑似UTI患者的1000份尿液样本。所有细菌均进行革兰氏染色，并且对产生单一形态型细菌的细菌进行 MALDI-TOF MS 处理。我们的序贯算法与标准半定量尿培养结果的相关性如下： 匹配，提供的信息是培养结果的预期；小错误，所提供的信息部分是对培养结果的预期；重大错误，提供的信息不正确，可能导致抗菌治疗的不当改变。 242/1000 个样本中获得阳性培养物。革兰氏染色显示 207 个样品中存在单一形态型，并对这些样品进行了 MALDI-TOF MS 分析。革兰氏染色的诊断性能为：敏感性（Se）81.3%，特异性（Sp）93.2%，阳性预测值（PPV）81.3%，阴性预测值（NPV）93.2%，阳性似然比（+LR）11.91，阴性似然比（−LR）0.20，准确度90.0%，而MALDI-TOF MS的诊断性能为：Se 79.2%，Sp 73.5，+LR 2.99，−LR 0.28，准确度 78.3%。两种技术的使用为 82.7% 的病例提供了预期培养结果的信息，为 13.4% 的病例提供了存在轻微错误的信息，为 3.9% 的病例提供了存在重大错误的信息。 1 小时内即可获得结果。我们的串行算法为疑似 UTI 患者的 96.1% 的尿液样本提供了一致的信息或显示出微小的错误。这种快速尿路感染诊断策略的临床影响需要通过治疗充分性指标来评估，例如减少适当经验治疗的时间或提前停用不必要的抗生素。
Microbiological confirmation of a urinary tract infection (UTI) takes 24–48 h. In the meantime, patients are usually given empirical antibiotics, sometimes inappropriately. We assessed the feasibility of sequentially performing a Gram stain and MALDI-TOF MS mass spectrometry (MS) on urine samples to anticipate clinically useful information. In May-June 2012, we randomly selected 1000 urine samples from patients with suspected UTI. All were Gram stained and those yielding bacteria of a single morphotype were processed for MALDI-TOF MS. Our sequential algorithm was correlated with the standard semiquantitative urine culture result as follows: Match, the information provided was anticipative of culture result; Minor error, the information provided was partially anticipative of culture result; Major error, the information provided was incorrect, potentially leading to inappropriate changes in antimicrobial therapy. A positive culture was obtained in 242/1000 samples. The Gram stain revealed a single morphotype in 207 samples, which were subjected to MALDI-TOF MS. The diagnostic performance of the Gram stain was: sensitivity (Se) 81.3%, specificity (Sp) 93.2%, positive predictive value (PPV) 81.3%, negative predictive value (NPV) 93.2%, positive likelihood ratio (+LR) 11.91, negative likelihood ratio (−LR) 0.20 and accuracy 90.0% while that of MALDI-TOF MS was: Se 79.2%, Sp 73.5, +LR 2.99, −LR 0.28 and accuracy 78.3%. The use of both techniques provided information anticipative of the culture result in 82.7% of cases, information with minor errors in 13.4% and information with major errors in 3.9%. Results were available within 1 h. Our serial algorithm provided information that was consistent or showed minor errors for 96.1% of urine samples from patients with suspected UTI. The clinical impacts of this rapid UTI diagnosis strategy need to be assessed through indicators of adequacy of treatment such as a reduced time to appropriate empirical treatment or earlier withdrawal of unnecessary antibiotics.
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DOI：
10.1016/0732-8893(84)90028-2
发表时间：
1984-01-01
影响因子：
2.9
作者：
CROUT, FV;TILTON, RC
通讯作者：
TILTON, RC
DOI：
10.1080/00480169.1968.33737
发表时间：
1968-01-01
期刊：
N Z VET J
影响因子：
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作者：
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影响因子：
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作者：
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通讯作者：
Brönnestam, R
影响因子：
14.2
作者：
Ferreira, L.;Sanchez-Juanes, F.;Gonzalez-Buitrago, J. M.
通讯作者：
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影响因子：
4.5
作者：
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Flanders SA