16S rRNA基因测序在儿童骨感染病原菌诊断中的临床价值

Clinical value of 16S rRNA gene sequencing in diagnosing childhood bone infection pathogens

目的总结比较 16S rRNA 基因测序和传统培养在儿童骨科感染性疾病病原菌诊断的临床意义。方法选择 2015 年 12 月至 2018 年1月上海儿童医学中心感染研究室所收集的临床怀疑感染的 41 例骨科样本进行 16S rRNA 基因测序,同时进行培养,分析并比较 16S rRNA 基因测序和传统培养在儿童骨感染病原菌诊断中的灵敏度、特异度和检测耗时等。结果 16S rRNA 基因测序灵敏度为 69.4%,传统培养的灵敏度为 38.9%,差异有统计学意义(χ~2=6.769,P=0.009);两者特异度均为 100%。16S rRNA 基因测序检测耗时3~24 h 明显少于传统培养 2~5天。结论 16S rRNA 基因测序较传统培养灵敏度高、耗时短,可检测出传统培养阴性的病原体,对儿童骨感染病原菌的早期诊断具有一定的应用价值,在临床少见菌、苛养菌以及固体培养基不生长细菌的鉴定具有独特优势,可作为传统培养方法的一个有效补充。

Objective To summarize and compare the clinical significance of 16S rRNA gene sequencing and traditional culture in diagnosing pathogenic bacteria in children with orthopedic infectious diseases. Methods Fourty-one orthopedic specimens were collected by Department of Infectious Diseases, Shanghai Children’s Medical Center, from December 2015 to January 2018. All specimens were cultured and detected by 16S rRNA gene sequencing simultaneously. The sensitivity and specificity of traditional culture and 16S rRNA gene sequencing were statistically analyzed and compared. Results The sensitivity of 16S rRNA gene sequencing and traditional culture were 69.4% and 38.9% respectively with statistical significance (χ~2=6.769, P=0.009). The specificities of the two methods were both 100%. The turn around time (TAT) of 16S rRNA gene sequencing 3-24 h was significantly shorter than that of the traditional culture 2-5 d. Conclusions Compared to traditional culture, 16S rRNA gene sequencing has higher sensitivity and shorter TAT, and can detect traditional culture-negative pathogens as well. Besides certain application value for early diagnosis of bone infection pathogens in children, 16S rRNA gene sequencing has unique advantages in the identification of rare, fastidious and solid medium non-growing bacteria, thus can be used as an effective supplement to traditional culture.