恒温扩增芯片法与微生物培养法在重症监护室环境检测中的比较

Comparison of loop-mediated isothermal amplification and microbial culture method in ICU environmental monitoring

目的研究恒温扩增(LAMP)芯片法在重症监护室(ICU)环境物品卫生学检测中的应用价值。方法某医院综合ICU及各专科ICU于2020年1月至2022年6月疑似出现9次医院感染暴发,对27例患者周围环境物品进行采样,共计679份样本。同时使用LAMP芯片法及微生物培养鉴定法检测样本,比较2种检测方法检测阳性率、检测时间及检测一致性。结果679份样本通过LAMP芯片法检出阳性样本233份,阳性率34.32%;微生物培养鉴定法检出阳性样本136份,阳性率20.03%,2种方法检出率差异有统计学意义(P<0.001)。恒温扩增芯片法病原菌检出时间(2.08±0.048)h明显低于微生物培养鉴定法(55.56±13.873)h(P<0.001)。2种检测方法阳性率检出最高的部位均为呼吸机冷凝水。恒温扩增芯片法对鲍曼不动杆菌、金黄色葡萄球菌、肺炎克雷伯菌检测阳性率均比微生物培养鉴定法检测阳性率高(P<0.001),2种方法对鲍曼不动杆菌、肺炎克雷伯菌检测结果具有中等一致性(0.4≤Kappa值<0.75),金黄色葡萄球菌检测结果一致性较低(Kappa值<0.4)。结论恒温扩增芯片法用于重症监护室环境物品卫生学检测快速、便捷。

Objective To investigate the value of loop-mediated isothermal amplification(LAMP)in the hygienic detection of pathogens environmental articles in intensive care unit(ICU).Methods From January 2020 to June 2022,9 suspected outbreaks of nosocomial infection occurred in the general ICU and other specialized ICU of a hospital,and 679 specimens were collected from 27 patients'surroundings.LAMP and microbial culture method were used to detect specimens,and the positive rate,detection time and detedion consistenay of the two detection methods were compared.Results Among 679 specimens,233 were positive by LAMP,with a positive rate of 34.32%,and 136 positive samples were detected by microbial culture method,with a positive rate of 20.03%.The difference in the detection rate between the two methods was statistically significant(P<0.001).The detection time of LAMP method was(2.08±0.048)h,which significantly lower than that in microbial culture method with(55.56±13.873)h(P<0.001).The positive rate of condensate water of the ventilator were the highest in both detection methods.The positive rates of LAMP method for Acinetobacter Baumannii,Staphylococcus aureus and Klebsiella pneumoniae were higher than those of microbial culture method(P<0.001).The results of the two methods for Acinetobacter Baumannii and Klebsiella pneumoniae showed moderate consistency(0.4≤Kappa<0.75),while the consistency of the results of Staphylococcus aureus was low(Kappa<0.4).Conclusion LAMP is rapid and convenient for hygienic detection of pathogens environmental articles in ICU.