Servicio de Microbiología Clínica, Hospital Universitario La Paz, IdiPAZ, Paseo de La Castellana, 261, 28046, Madrid, Spain.
Eur J Clin Microbiol Infect Dis. 2017 Dec;36(12):2469-2473. doi: 10.1007/s10096-017-3086-5. Epub 2017 Aug 23.
We have performed a retrospective, before-after comparison of turnaround time and therapy adjustment parameters before and after the introduction of matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) plus mecA polymerase chain reaction (PCR) for the identification of methicillin-resistant Staphylococcus aureus (MRSA) in positive blood cultures. There were 227 episodes of S. aureus bacteremia during the study periods. The pre-MALDI-TOF and post-MALDI-TOF groups included 133 and 94 patients, respectively. The two rapid methods performed sequentially decreased the turnaround time of MRSA identification by nearly 50% (2.06 ± 1.95 vs. 3.95 ± 1.70 days). There was no significant reduction in the length of hospitalization (28.27 ± 32.16 vs. 28.62 ± 28.75 days). In both groups, the adequacy of the empirical antibacterial therapy was similar (59.49% vs. 51.31%), but the optimization of the therapy was more frequent in the post-MALDI-TOF group. Routine implementation of these techniques provides results earlier than conventional methods and increases the proportion of episodes with adequate change of empirical to directed antimicrobial therapy.
我们对采用基质辅助激光解吸电离飞行时间（MALDI-TOF）加 mecA 聚合酶链反应（PCR）检测阳性血培养物中耐甲氧西林金黄色葡萄球菌（MRSA）前后的周转时间和治疗调整参数进行了回顾性、前后比较。在研究期间，有 227 例金黄色葡萄球菌菌血症发作。MALDI-TOF 检测前组和 MALDI-TOF 检测后组分别包括 133 例和 94 例患者。两种快速方法连续进行，将 MRSA 鉴定的周转时间缩短了近 50%（2.06±1.95 天 vs. 3.95±1.70 天）。住院时间无明显缩短（28.27±32.16 天 vs. 28.62±28.75 天）。在两组中，经验性抗菌治疗的充分性相似（59.49% vs. 51.31%），但 MALDI-TOF 检测后组中治疗优化更为频繁。常规实施这些技术比传统方法提供更早的结果，并增加了经验性治疗向靶向抗菌治疗充分改变的发作比例。
