VITEK-2 Compact全自动微生物鉴定仪与VITEK MS质谱仪在摩根摩根菌鉴定中的应用及评价

目的分析研究VITEK-2 Compact全自动微生物鉴定仪与VITEK MS质谱仪在摩根摩根菌鉴定中的应用及对其鉴定结果的准确性做出评价,为临床精准治疗提供科学依据。方法收集2017年1月至2020年5月云南省第三人民医院送检的不同类型标本中分离出的50株摩根摩根菌;常规方法进行菌株培养;采用VITEK-2 Compact全自动微生物鉴定仪,手工生化补充试验和VITEK MS质谱仪对菌株进行菌种鉴定,鉴定结果不一致的菌株采用16S rDNA测序验证。结果共分离出5株β溶血表型和45株非β溶血表型摩根摩根菌;VITEK-2 Compact全自动微生物鉴定仪对非β溶血摩根摩根菌鉴定结果均符合,对β溶血摩根摩根菌鉴定结果均不符合,且均鉴定为奇异变形杆菌,鉴定符合率为90%;手工生化补充试验结果也符合奇异变形杆菌;VITEK MS质谱仪对非β溶血和β溶血摩根摩根菌的鉴定结果均符合,鉴定符合率为100%;16S rDNA测序对鉴定结果不一致的5株β溶血菌的测序结果均为摩根摩根菌。结论 VITEK-2 Compact全自动微生物鉴定仪对非β溶血摩根摩根菌的鉴定结果准确可信;对β溶血摩根摩根菌鉴定结果均不准确,且鉴定为奇异变形杆菌的概率很高;VITEK MS质谱仪对摩根摩根菌的鉴定结果均准确快速且不受细菌β溶血与否影响。     

ESP全自动血培养仪的临床应用及评价

目的评价ESP全自动血培养仪(简称ESP)临床应用情况。方法用ESP检测2147份血标本,观察其阳性检出率、检出时间,并对所检出细菌的种类及阳性率进行分析。结果2147份血标本中ESP提示阳性322例,分离出294株细菌,阳性率为13．7％,最快检出时间为2h,24h内检出的阳性数占60．5％,48h内检出的阳性数占83．3％,72h检出的阳性数占99％。假阳性率为0．87％。未发现假阴性。结论应用ESP有较高阳性检出率,缩短了培养时间,增加了检出细菌的种类,结果快速、准确。     

ESP全自动血培养仪的临床应用及评价

目的　评价ESP全自动血培养仪(简称ESP)临床应用情况。方法　用ESP检测2147份血标本,观 察其阳性检出率、检出时间,并对所检出细菌的种类及阳性率进行分析。结果　2147份血标本中ESP提示阳性 322例,分离出294株细菌,阳性率为13.7%,最快检出时间为2h,24h内检出的阳性数占60.5%,48h内检出 的阳性数占83.3%,72h检出的阳性数占99%。假阳性率为0.87%。未发现假阴性。结论　应用ESP有较高 阳性检出率,缩短了培养时间,增加了检出细菌的种类,结果快速、准确。     

BD BACTEC 9120全自动血培养仪阳性结果分析

目的评价BD BACTEC 9120全自动血培养仪阳性结果中的菌群类型和假阳性/假阴性情况。方法分析3100份临床标本中的病原菌种类和出现的假阳性/假阴性率及原因。结果BD BACTEC 9120全自动血培养仪假阳性率和假阴性率分别为6.35%和1.32%,假阳性中以白细胞增多和肿瘤患者为多。所有致假阴性菌种中,以真菌的比率最高;血培养病原菌以金黄色葡萄球菌和大肠埃希菌为多,分别为42.5%和25.5%。结论了解血培养菌群类型有助于指导临床用药,对BD BACTEC 9120血培养仪报道的阴性结果必须进行传代培养。     

miniVital血培养仪检测革兰阳性球菌及真菌的评价

为了评价全自动血培养仪miniVital对金黄色萄萄球菌 ,凝固酶阴性葡萄球菌 ,肠球菌等革兰阳性球菌及真菌的检测能力 ,分别用上述微生物的 18～ 2 4h培养物配制浓度 10 8～10 0 CFU/ml的菌液 ,用新血培养瓶和临床阴性培养瓶分别制作直接模拟标本和临床模拟标本 ,每个菌种每个浓度同时无菌接种需氧及厌氧瓶二份作平行实验 ,将模拟标本放入miniVital中进行连续培养监测 ,记录阳性报告时间。分析miniVital对四种微生物的检测情况。结果 :直接模拟标本 2 4h内阳性率为 10 0 % ,阳性报告时间随菌液浓度增加而缩短。临床模拟标本总阳性率为 94 .4…     

使用BacT／Alert240全自动血培养仪与革兰阴性杆菌假阴性的分析

目的：分析全自动血培养仪BacT/Alert240临床应用中存在的假阴性原因，找出解决的办法，提高全自动血培养阳性率。方法：BacT/Alert240全自动血培养仪对不同浓度及不同孵育时间的革兰阴性杆菌进行检测。结果：BacT/Alert240全自动血培养仪对于非发酵菌的检测存在假阴性，35℃预孵时间和血培养中的细菌浓度对于非发酵菌的检测也有影响。结论：BacT/Alert240全自动血培养仪虽大大提高了血培养的阳性率，但对于非发酵菌的检测并不理想。我们认为实验室前质控是一个重要因素，BacT/Alert240全自动血培养仪对于非发酵菌的检测有待改进。     

VersaTREK全自动血培养仪的临床应用及评价

目的 评价VersaTREK240-4全自动血培养仪的临床应用情况.方法 采用回顾性分析,对VersaTREK240-4全自动血培养仪检测930例标本,检出阳性的时间、细菌种类及阳性率进行评估.结果 VersaTREK240-4最短检出时间4 h,最长52 h,12 h以内阳性者为21.9%,24 h以内阳性者为68.3%,48 h以内阳性者90.2%,72 h以内阳性者100%,细菌种类31种,阳性率15.4%.结论 VersaTREK240-4无论从出现阳性的时间、检出细菌种类包括营养条件高的苛养菌阳性率均明显高于本室往年手工的结果,而且操作简便、结果快速、准确.     

mini VITAL全自动血培养仪假阳性/假阴性结果分析

目的　评价miniVITAL全自动血培养仪在临床应用中的假阳性 /假阴性情况。方法　采用回顾性分析 ,对miniVITAL全自动血培养仪在检测 3834份临床标本中出现的假阳性 /假阴性率及导致假阴性结果的细菌种类与分布进行评估分析。结果　miniVITAL系统假阳性率和假阴性率分别为 0 .6 8%和 0 .70 % ,所有致假阴性菌种中 ,以真菌的比率最高 ,占 6 2 .0 7% ,其次为非发酵菌、草绿色链球菌、凝固酶阴性葡萄球菌、革兰阳性杆菌和厌氧菌 ,分别为 10 .34%、10 .34%、6 .90 %、6 .90 %和 3.4 5 %。结论　对miniVITAL系统血培养仪报告的阴性结果必须同时进行细菌和真菌的传代培养     

BacT/Alert 240全自动血培养仪的临床应用及评价

目的：评价全自动血培养仪BacT/Alert 240的临床应用情况，方法：回顾性分析BacT/Alert240全自动血培养系统检测7124份标本的阳性率，阳性检出时间，细菌种类以及假阳性率，假阴性率和污染率，结果：7124份血培养分离到804株微生物，其中细菌764株，阳性率11．5％，最快阳性检出时间2小时，24小时内检出的阳性占69．9％，48小时内占87．3％，72小时内占91．3％，804株细菌分布于24个属，假阳性率4．9％，假阴性率0．4％，污染率0．3％，结论：BacT/Alert 240全自动血培养仪提高了血培养的阳性率，缩短了阳性检出时间，检出细菌种类多尤其是苛养菌阳性率增加，减少污染机会，而且操作简便，结果快速，准确。     

Laboratory-based evaluation of the colorimetric VITEK-2 Compact system for species identification and of the Advanced Expert System for detection of antimicrobial resistances: VITEK-2 Compact system identification and antimicrobial susceptibility testing

The newly redesigned colorimetric VITEK-2 Compact system with updated Advanced Expert System (AES) (bioMerieux, Marcy l'Etoile, France) was evaluated for its accuracy and rapidity to identify clinical isolates and to detect several antimicrobial resistances. Overall, the VITEK-2 gave 95.8% of compatibility with the reference API strips (bioMerieux) in the identifications (IDs) of Gram-positive cocci (GPC), Gram-negative rods (GNR), and yeasts. The accuracy was finally estimated to 98.3% through additional confirmatory tests. Also, >90% of IDs of GPC and GNR were obtained within 7 h of incubations. The VITEK AES correctly detected 97.7% of antimicrobial resistances, including extended-spectrum beta-lactamases, oxacillin and inducible clindamycin resistances in staphylococci, vancomycin resistance in enterococci, and penicillin and erythromycin resistances in Streptococcus pneumoniae. The most resistant isolates were identified within 12 h of incubations. In conclusion, the new colorimetric VITEK-2 Compact system with AES greatly improved its accuracy in species ID and detection of antimicrobial resistances, and it will be highly acceptable to clinical microbiology laboratory function.     

某地区小儿血流感染病原菌分布及耐药性分析

目的探讨北海地区小儿患者血流感染(BSI)病原菌分布及其耐药性。方法回顾性分析2013年1月至2016年6月发生BSI的小儿患者临床资料。结果本地区95.3%的小儿BSI为社区获得性感染。革兰阳性球菌与阴性杆菌所占比例分别为53.5%、46.5%。万古霉素、利奈唑胺对阳性球菌耐药率均为0.0%;哌拉西林、哌拉西林/他唑巴坦、头孢吡肟、美罗培南对革兰阴性杆菌的耐药率分别9.3%、0.0%、9.1%、5.0%。结论革兰阳性球菌与阴性杆菌感染比例基本一致。万古霉素、利奈唑胺可作阳性球菌BSI的经验用药;哌拉西林、哌拉西林/他唑巴坦、头孢吡肟、美罗培南可作革兰阴性杆菌BSI的经验用药。     

Direct inoculation method using BacT/ALERT 3D and BD Phoenix System allows rapid and accurate identification and susceptibility testing for both Gram-positive cocci and Gram-negative rods in aerobic blood cultures

This study describes a direct inoculation method using the automated BacT/ALERT 3D and the BD Phoenix System in combination for identification and susceptibility testing of isolates from positive blood cultures. Organism identification and susceptibility results were compared with the conventional method for 211 positive aerobic blood cultures. Of 110 Gram-positive cocci (GPCs), 98 (89.1%) isolates were correctly identified to the species level. Of 101 Gram-negative rods (GNRs), 98 (97.0%) isolates were correctly identified to the species level. The overall categorical agreement in antimicrobial susceptibility testing among the 110 GPCs was 92.7%, with 0.04% very major and 0.7% major error rates. The overall categorical agreement among 78 isolates of enterobacteria and 23 isolates of nonfermenters in GNRs was 99.5% and 91.1%, respectively, with no major errors identified. We conclude that, compared with previously reported direct inoculation methods, our method is superior in identification and susceptibility testing of GPCs.     

2010~2011年血培养病原菌分布和耐药性分析

目的 研究该院2010~2011年血培养病原菌分布及耐药性.方法 回顾性分析该院2010~2011年血培养标本病原菌检出情况及其药敏试验结果.结果 10 128例血培养标本共检出病原菌1 276株,革兰阴性杆菌、革兰阳性球菌及真菌分别占57.1%(728/1 276)、33.4%(426/1 276)、9.5%(121/1 276).革兰阳性球菌以表皮葡萄球菌、金黄色葡萄球菌、肠球菌等为主,对万古霉素、替考拉宁和利奈唑胺均敏感;粪肠球菌耐药率低于屎肠球菌.革兰阴性菌以大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌为主;超广谱β内酰胺酶阳性肠杆菌科细菌耐药率高于阴性株.碳青霉烯类对大肠埃希菌、肺炎克雷伯菌的抗菌活性强于铜绿假单胞菌、鲍曼不动杆菌.真菌以白色假丝酵母菌为主.结论 2010~2011年该院血液感染患者较多,应重视血培养标本检测及致病菌耐药性分析,应根据药敏实验结果 及耐药趋势合理应用抗菌药物.     

Rapid identification of pathogens from positive blood cultures by multiplex polymerase chain reaction using the FilmArray system

Sepsis is a leading cause of death. Rapid and accurate identification of pathogens and antimicrobial resistance directly from blood culture could improve patient outcomes. The FilmArray® (FA; Idaho Technology, Salt Lake City, UT, USA) Blood Culture (BC) panel can identify >25 pathogens and 4 antibiotic resistance genes from positive blood cultures in 1 h. We compared a development version of the panel to conventional culture and susceptibility testing on 102 archived blood cultures from adults and children with bacteremia. Of 109 pathogens identified by culture, 95% were identified by FA. Among 111 prospectively collected blood cultures, the FA identified 84 (91%) of 92 pathogens covered by the panel. Among 25 Staphylococcus aureus and 21 Enterococcus species detected, FA identified all culture-proven methicillin-resistant S. aureus and vancomycin-resistant enterococci. The FA BC panel is an accurate method for the rapid identification of pathogens and resistance genes from blood culture.     

全自动细菌鉴定仪直接鉴定血培养阳性标本的临床应用

目的探讨全自动细菌鉴定仪对血培养阳性标本直接鉴定和药敏试验的临床应用价值及其与常规法（转种后取得的纯菌落上机鉴定及药敏试验）的符合率。方法将血培养阳性标本的培养液混匀于专用接种水中,接种于专用鉴定板上直接上机做细菌鉴定和药敏试验,并与转种后取得的纯菌落上机鉴定及药敏结果进行比较。结果86例血培养阳性标本直接上机与转种菌落上机鉴定结果差异无统计学意义（P〈0．01）,血培养阳性标本直接上机与转种菌落上机的药敏试验结果符合率大于95．5％。而直接法比常规法约提前24h。结论对血培养阳性标本进行直接鉴定及药敏试验缩短了检验时间,为菌血症的治疗争取了时间,且与常规法的实验结果符合率高。     

237例血培养阳性结果分析

目的：对血培养病原菌的种类分布和耐药情况进行回顾性分析,为临床用药提供依据。方法采用VersaTREK全自动血培养仪及配套血培养瓶连续监测培养细菌,阳性瓶及时转种。用MicroScan A/S-4微生物分析仪及配套试剂对分离菌进行鉴定和药敏试验。结果2460例血培养标本中共分离出237株病原菌,居前5位的病原菌依次为凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌和肠球菌。临床分布以ICU、普外科及呼吸内科为主。药敏结果显示：革兰阴性杆菌对亚胺培南高度敏感,未发现耐万古霉素和利奈唑胺的革兰阳性球菌。结论及时了解血培养结果可以为临床抗菌治疗提供依据,对提高治愈率有重要的意义。     

Direct identification of bacteria in positive blood cultures: comparison of two rapid methods,FilmArray and mass spectrometry

We evaluated the accuracy and performance of the FilmArray Direct from Positive Blood Culture system (BCID) (BioFire Diagnostics, Salt Lake City, UT, USA) and the VITEK Mass Spectrometry System (Vitek MS; bioMerieux, Durham, NC, USA) to identify bacterial isolates from 161 positive blood culture bottles. The BCID uses multiplex PCR to identify 90–95% of common isolates to the genus or species/complex level as well as mecA, Van A/B, and bla_KPC genes in approximately 1 hour. Of 151 monomicrobic isolates, the FilmArray correctly identified 48/49 (98%) to the genus and 84/84 (100%) to the species/complex level, while 18/151 (12%) gave no identification, as expected from the database. Mass spectrometry correctly identified 142/151 (94%) monomicrobic cultures to the genus level, 137/151 (91%) to the species level, with only 8/151(5%) giving no identification. Although mass spectrometry has a much larger database, the filtration system was cumbersome in contrast to the 3–5 minutes hands-on-time for the BCID.     

Direct mecA polymerase chain reaction testing of blood culture bottles growing Gram-positive cocci and the clinical potential in optimizing antibiotic therapy for staphylococcal bacteremia

This study evaluated the performance of direct mecA polymerase chain reaction (PCR) from blood culture bottles growing Gram-positive cocci in clusters and its role in optimization of antibiotic therapy. A total of 266 blood cultures including 121 methicillin-resistant and 122 methicillin-susceptible Staphylococci were tested for mecA. Compared to phenotypic testing, the overall performance of direct mecA PCR was 99% for sensitivity, specificity, positive predictive value, and negative predictive value, respectively. Assessment of antibiotic therapy upon microbiology reporting of direct mecA PCR results from 38 patients prior to (phase I) and 48 patients after implementation of testing and reporting (phase II) showed that the mean time to antibiotic optimization in phase II (0.9 ± 0.9 day) was significantly shorter than that in phase I (2.2 ± 3.2 days) (P < 0.05). Methicillin-susceptible staphylococcal bacteremias had significantly higher frequency of antibiotic adjustment upon direct mecA reporting, compared to methicillin-resistant staphylococcal bacteremias. Our study indicated that direct mecA PCR improved timely antibiotic optimization.