MALDI-TOF MS技术快速鉴定肺炎克雷伯菌效果及其耐药性分析

Effects of MALDI-TOF MS technique on the rapid identification of Klebsiella pneumoniaand drug resistance analysis

目的观察基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)技术快速鉴定肺炎克雷伯菌的效果,并分析肺炎克雷伯菌的耐药性。方法收集2018年6月—2019年5月本院3564例患者痰液或咽拭子及粪便或肛拭子送检标本中分离的89株肺炎克雷伯菌菌株,均经16S rDNA基因序列分析证实,采用MALDI-TOF MS对其进行分离鉴定,并分析肺炎克雷伯菌耐药性。结果MALDI-TOF MS对肺炎克雷伯菌鉴定正确率为96.63%,与16S rDNA基因序列分析结果比较差异不具有统计学意义(P>0.05)。肺炎克雷伯菌主要分布在秋季(26.97%)和冬季(42.70%),夏季(12.36%)最少。肺炎克雷伯菌对美罗培南、亚胺培南、庆大霉素、左氧氟沙星、哌拉西林/他唑巴坦敏感性强,依次为97.75%、95.51%、89.89%、83.15%、80.90%,对哌拉西林、头孢唑林、头孢呋辛、头孢他啶耐药性强,依次为95.51%、69.66%、51.69%、34.83%。呼吸道分离肺炎克雷伯菌对氨曲南、头孢他啶耐药性高于肠道,差异具有统计学意义(P<0.05)。结论MALDI-TOF MS技术可快速鉴定肺炎克雷伯菌,且结果准确;肺炎克雷伯菌对美罗培南、亚胺培南敏感性最强,对哌拉西林耐药性最强。

Objective To observe the effects of matrix-assisted laser desorption ionization-time of flight mass spectrometry(MALDI-TOF MS)technique on the rapid identification of Klebsiella pneumonia and analyze the drug resistance of Klebsiella pneumonia.Methods Eighty-nine strains of Klebsiella pneumonia isolated from sputum or throat swabs and stool or anal swab samples from 3564 patients were collected during June 2018 and May 2019,and they were confirmed by 16S rDNA genesequence analysis,and MALDI-TOF MS was used for isolation and identification,and the drug resistance of Klebsiella pneumonia was analyzed.Results The correctidentification rate of MALDI-TOF MS for Klebsiella pneumonia was 96.63%,which was not significantly different from that of 16S rDNA gene sequence analysis(P>0.05).The season distribution of Klebsiella pneumonia was mainly in autumn(26.97%)and winter(42.70%),and the least in summer(12.36%).Klebsiella pneumonia was strongly sensitive to meropenem,imipenem,gentamicin,levofloxacin and piperacillin/tazobactam,the sensitivity were 97.75%,95.51%,89.89%,83.15%and 80.90%,respectively.And it was strongly resistant to piperacillin,cefazolin,cefuroxime and ceftazidime,the resistant rates were 95.51%,69.66%,51.69%and 34.83%.Klebsiella pneumoniaisolated from respiratory tract presented higher drug resistance to aztreonam and ceftazidimethan those from intestinal tract(P<0.05).Conclusions MALDI-TOF MS technique could rapidly identify Klebsiella pneumonia,and the results is accurate.Klebsiella pneumonia is most sensitive to meropenem and imipenem,and has strongest resistant to piperacillin.