Faster identification of pathogens in positive blood cultures by fluorescence in situ hybridization in routine practice
Faster identification of pathogens in positive blood cultures by fluorescence in situ hybridization in routine practice
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DOI：
10.1128/jcm.44.1.119-123.2006
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发表时间：
2006-01-01
影响因子：
9.4
通讯作者：
van Agtmael, MA
中科院分区：
文献类型：
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作者：
Peters, RPH;Savelkoul, PHM;van Agtmael, MA
需要在血液培养中快速鉴定微生物，以便在早期阶段优化经验性治疗。荧光原位杂交（FISH）可以减少对生长阳性血液培养物中微生物的鉴定时间。在这项研究中，我们评估了FISH与常规培养方法相比的性能、识别时间和潜在的临床益处。革兰氏染色后，血培养液同时用FISH和常规培养方法进一步鉴定。收集鱼和培养物鉴定（临时鉴定和最终鉴定）的结果和时间点并进行比较。对于91%的微生物，可以确定属名或科名，对于79%的微生物，可以归因于种名。除肠杆菌科（Enterobacteriaceae）外，其他探针的灵敏度和特异性均超过95%。用肺炎克雷伯菌探针对产后克雷伯菌进行交叉杂交。细菌和酵母的FISH和最终培养鉴定的时间增益分别大于18 h和42 h。与临时鉴定相比，FISH对金黄色葡萄球菌与凝固酶阴性葡萄球菌的鉴别速度快1.4 h （P < 0.001）。总之，FISH可以快速可靠地鉴定生长阳性血液培养物中的大多数微生物。FISH鉴定获得的大量时间可以使抗菌治疗在同一天进行调整，如果没有获得临时鉴定，FISH尤其有用。随着探针数量的进一步增加和周转时间的缩短，FISH将成为血流感染诊断中非常有用的诊断工具。
Rapid identification of microorganisms in blood cultures is required to optimize empirical treatment at an early stage. Fluorescence in situ hybridization (FISH) can reduce the time to identification of microorganisms in growth-positive blood cultures. In this study, we evaluated the performance, time to identification, and potential clinical benefits of FISH compared to those of conventional culture methods in routine practice. After Gram staining, blood culture fluids were simultaneously further identified with FISH and with conventional culture methods. Results and points in time of FISH and culture identification (provisional and final identifications) were collected and compared. For 91% of microorganisms, the genus or family name was identified, and for 79%, the species name could be attributed. The sensitivity and specificity of the individual probes exceeded 95%, except for the Enterobacteriaceae probe (sensitivity, 89%). Cross-hybridization was obtained with the Klebsiella pnemoniae probe for Klebsiella oxytoca. The time gains of FISH and final culture identification were more than 18 h for bacteria and 42 h for yeasts. With FISH, Staphylococcus aureus was differentiated from coagulase-negative staphylococci 1.4 h faster than by provisional identification (P < 0.001). In conclusion, FISH allows rapid and reliable identification of the majority of microorganisms in growth-positive blood cultures. The substantial time gain of identification with FISH may allow same-day adjustment of antimicrobial therapy, and FISH is especially useful if no provisional identification is obtained. With further extension of the number of probes and a reduction in turnaround time, FISH will become a very useful diagnostic tool in the diagnosis of bloodstream infections.