基于MALDI-TOF MS快速鉴定脑脊液中病原菌的方法建立及识别能力评价

Rapid identification of pathogenic bacteria in cerebrospinal fluid based on MALDI-TOF MS method and identification ability evaluation

目的研究基于基质辅助激光解析电离飞行时间质谱(MALDI-TOF MS)快速鉴定脑脊液中病原菌的方法建立及识别能力。方法本研究为前瞻性研究,选择2019年5月至2021年5月来河南省儿童医院进行治疗的中枢神经系统感染患者的脑脊液样本90例作为研究对象,分别对以上样本进行基于MALDI-TOF MS快速鉴定以及常规细菌培养,分别对以上样品进行病原菌鉴定以及药敏试验结果分析。结果本研究中共计鉴定革兰氏阴性菌38例,革兰氏阳性菌42例,真菌10例。本研究中利用短期培养物MALDI-TOF MS鉴定的总体正确率为92.22%。其中革兰氏阴性菌的鉴定正确率为82.33%,革兰氏阳性菌的鉴定正确率为95.23%,真菌的鉴定正确率为90.00%;通过对革兰氏阴性菌对阿米卡星、苄卡西林、氨苄西林、氨曲南、头孢唑林、头孢吡肟、头孢他啶、头孢呋辛、环丙沙星、庆大霉素、亚胺培南、左氧氟沙星、美罗培南、呋喃妥因、哌拉西林、妥布霉素、复方新诺明等抗生素的耐药情况进行短期培养以及常规药敏实验分析显示,两种方法的诊断一致性较强,通过对革兰氏阳性菌对氨苄西林、青霉素、环丙沙星、克林霉素、红霉素、庆大霉素、左氧氟沙星、利奈唑胺、莫西沙星、呋喃妥因、苯唑西林、利福平、美罗培南、四环素、替加环素、复方新诺明、万古霉素等抗生素的耐药情况进行短期培养以及常规药敏实验分析显示,两种方法的诊断一致性较强。结论基于MALDI-TOF MS快速鉴定脑脊液中病原菌的结果与常规培养检测方法一致,可作为临床治疗的重要依据。

【Objective】To study the establishment and identification ability of rapid identification of pathogenic bacteria in cerebrospinal fluid based on matrix-assisted laser desorption ionization-time of flight mass spectrometer(MALDI-TOF MS).【Methods】In this prospective study,90 cases of cerebrospinal fluid samples from patients with central nervous system infection who were treated in our hospital from May 2019 to May 2021 were selected as the research objects.Rapid identification based on MALDI-TOF MS and routine bacterial culture were performed on the above samples respectively.The above samples were identified by pathogen and the results of drug sensitivity test were analyzed.【Results】A total of 38 Gram-negative bacteria,42 Gram-positive bacteria and 10 fungi were identified in this study.In this study,the overall accuracy of MALDI-TOF MS identification using short-term culture was 92.22%.The identification accuracy of Gram-negative bacteria,Gram-positive bacteria and fungi was 82.33%,95.23%and 90.00%respectively.Through short-term culture and routine drug sensitivity analysis of Gram-negative bacteria resistant to antibiotics such as amikacin,benzylcacillin,ampicillin,aztreonam,cefazolin,cefepime,ceftazidime,cefuroxime,ciprofloxacin,gentamycin,imipenem,levofloxacin,meropenem,nitrofurantoin,piperacillin,tobramycin,and SMZco,the two methods have strong consistency in diagnosis.Through short-term culture and routine drug sensitivity analysis of Gram positive bacteria resistant to antibiotics such as ampicillin,penicillin,ciprofloxacin,clindamycin,erythromycin,gentamicin,levofloxacin,linezolid,moxifloxacin,nitrofurantoin,oxacillin,rifampicin,meropenem,tetracycline,tigecycline,SMZco,vancomycin,the two methods have strong consistency in diagnosis.【Conclusion】The results of rapid identification of pathogenic bacteria in cerebrospinal fluid based on MALDI-TOF MS are consistent with the conventional culture detection method,which can be used as an important basis for clinical treatment.