Luethy Paul M, Johnson J Kristie
Department of Pathology, University of Maryland School of Medicine, Baltimore, MD.
J Appl Lab Med. 2019 Jan;3(4):675-685. doi: 10.1373/jalm.2018.027318. Epub 2018 Sep 13.
Sepsis is a life-threatening condition with high rates of morbidity and mortality; effective and appropriate antibiotic therapy is essential for ensuring patient improvement. To aid in the diagnosis of sepsis, blood cultures are drawn and sent to the microbiology laboratory for pathogen growth, identification, and susceptibility testing. The clinical microbiology laboratory can assist the medical team by providing timely identification of the pathogen(s) causing the bloodstream infection through the use of rapid diagnostic technology. One of these rapid diagnostic technologies, MALDI-TOF MS, has been proven to reduce the time required for appropriate antibiotic therapy when used to identify pathogens grown in culture. This technology has also been used to identify pathogens directly from the positive blood cultures with great success.
In this minireview, we summarize the different methods that have been developed to directly identify pathogens from positive blood cultures by use of MALDI-TOF MS and the effect of this technology on patient outcomes. Additionally, we touch on current research in the field, including the identification of antimicrobial resistance directly from positive blood cultures by MALDI-TOF MS.
Rapid identification of pathogens is important in the survival of patients undergoing a septic event. MALDI-TOF MS technology has played an important role in rapid identification, which has led to a reduction in the time to appropriate antibiotic therapy and contributed to the improvement of patient outcomes. The high sensitivity and specificity of MALDI-TOF MS identification, in combination with MALDI-TOF's rapid function and reduced labor costs, make this technology an attractive choice for clinical laboratories.
脓毒症是一种危及生命的疾病,发病率和死亡率很高;有效且恰当的抗生素治疗对于确保患者病情好转至关重要。为辅助脓毒症的诊断,需采集血培养样本并送至微生物实验室,以进行病原体培养、鉴定和药敏试验。临床微生物实验室可通过运用快速诊断技术及时鉴定引起血流感染的病原体,从而协助医疗团队。基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)就是其中一种快速诊断技术,已被证明在用于鉴定培养出的病原体时,可缩短给予恰当抗生素治疗所需的时间。这项技术还成功用于直接从阳性血培养物中鉴定病原体。
在本综述中,我们总结了已开发出的利用MALDI-TOF MS直接从阳性血培养物中鉴定病原体的不同方法,以及该技术对患者预后的影响。此外,我们还涉及了该领域的当前研究,包括利用MALDI-TOF MS直接从阳性血培养物中鉴定抗菌药物耐药性。
快速鉴定病原体对于脓毒症患者的生存至关重要。MALDI-TOF MS技术在快速鉴定方面发挥了重要作用,这使得给予恰当抗生素治疗的时间得以缩短,并有助于改善患者预后。MALDI-TOF MS鉴定的高灵敏度和特异性,再加上其快速功能和降低的劳动力成本,使该技术成为临床实验室颇具吸引力的选择。