血小板制品细菌污染的核酸检测方法评价

目的探讨实时荧光定量PCR法检测血小板制品中细菌污染的C t值用于血液细菌污染筛查的可行性。方法用实时荧光定量PCR技术检测单采血小板样本740份,包括420份阳性样本及320份阴性样本。通过受试者工作特征曲线(ROC)分析检测结果,确定最佳工作点的特异性和灵敏度。结果通过对检测结果C t值分析,确定最佳工作点即C t值在31.97时灵敏度和特异性分别为99.4%和99.3%。通过对不同诊断点的结果分析初步确定C t值<31.97时发阳性报告,>33.00时发阴性报告,之间则为疑似样本。结论通过ROC曲线分析证实血小板制品细菌污染的实时荧光定量PCR检测法是一种高效、可靠、便于临床应用的检测手段。     

应用实时荧光定量PCR方法检测血小板制品细菌污染

目的应用实时荧光定量PCR方法检测血小板制品中细菌的探讨。方法选取金黄色葡萄球菌及大肠埃希氏杆菌,用改良的Chelex-100法抽提细菌基因组DNA,进行荧光定量PCR检测。并应用过滤法去除反应体系中潜在的细菌及其基因组DNA污染。结果针对16srRNA基因保守序列进行扩增的荧光定量PCR方法具有较高的特异性和灵敏度,与人类淋巴细胞及病毒等的基因组无交叉反应。在金黄色葡萄球菌检测中,应用过滤法后最低含菌量组与阴性对照组Ct值有极显著差异(P<0.001)。该方法对金黄色葡萄球菌的最低检出量为0.3CFUs/PCR,与阴性对照Ct值有显著差异(P<0.01),在大肠埃希氏杆菌中该法可检测出0.1CFUs/PCR,与阴性对照Ct值有显著性差异(P<0.01)。结论改良Chelex-100法抽提细菌基因组及后续的荧光定量PCR分析用于检测血小板制品中的细菌污染,检测实验缩短到3-4h,操作简单,灵敏性高,特异性好,为在临床标本大规模检测中的应用提供理论基础和实验数据。     

实时荧光定量PCR法与常规PCR法及细菌培养法检测副溶血弧菌的比较

目的:比较实时荧光定量PCR法、常规PCR法及细菌培养法检测副溶血弧菌的灵敏度与特异性。方法:采用建立的实时荧光定量PCR、常规PCR及传统细菌培养法3种方法,同时对副溶血弧菌等细菌进行检测。结果:实时荧光定量PCR检测的灵敏度可达19cfu/mL,且有很高的特异性,对金黄色葡萄球菌等10种相关细菌均无交叉反应,从细菌核酸提取至完成检测仅需3h左右。结论:实时荧光定量PCR检测由于在密封环境中进行,避免了产物与环境间的交叉污染,是3种方法中最为快速敏感的方法,适用于公共卫生应急疫情的实验室快速诊断。     

厌氧培养在单采血小板细菌筛查中的作用

目的分析增加厌氧培养是否降低血小板细菌污染引起的临床输血不良反应。方法采用全自动微生物培养检测系统对9 758份单采血小板进行需氧、厌氧培养,调查单采血小板厌氧培养的细菌检出率、检出时间、检出细菌的种类以及临床输注后的反应。结果需氧培养和厌氧培养的阳性率分别为0.06%(6/9 758)和0.16%(16/9 758),增加厌氧培养使细菌污染检出率从0.06%增加到0.16%,提高了2.6倍。其中有10份血小板样本仅在厌氧培养中检出的细菌,检出的细菌以疮疱丙酸杆菌等厌氧菌为主,检出时间为(96.8±18.21)h,检出时均已临床输注,未出现不良反应。结论增加厌氧培养可提高血小板细菌污染的检出率,但是本研究中厌氧瓶未在血小板发放使用前出现阳性信号。在目前我国逐步开展血小板细菌检测的情况下,可参考北美洲和中国香港的模式首先开展需氧培养以减少血小板细菌污染引起的临床输血不良反应。     

鲍曼不动杆菌耐药性快速检测方法的建立与评估

目的评估对实时荧光定量聚合酶链反应(PCR)快速检测鲍曼不动杆菌耐药性方法的效果。方法设计鲍曼不动杆菌(ATCC 19606)外膜蛋白A特异性探针,采用实时荧光定量PCR准确测定63株鲍曼不动杆菌经一定浓度庆大霉素、米诺环素、美罗培南、左氧氟沙星和头孢哌酮/舒巴坦孵育后的生长情况,比较抗菌药物孵育0和6h后鲍曼不动杆菌基因组DNA量,判断鲍曼不动杆菌耐药性,并与微量肉汤稀释法结果进行对比。结果建立的实时荧光定量PCR检测鲍曼不动杆菌耐药性方法与微量肉汤稀释法一致性高,Kappa值为0.879,P0.05。以微量肉汤稀释法为参考方法,实时荧光定量PCR的符合率达93.97%,灵敏度为92.53%,特异性为95.74%,阳性预测值为96.41%,阴性预测值为91.22%,Youden指数为0.88。结论实时荧光定量PCR与微量肉汤稀释法结果有高度一致性,且前者灵敏度高、特异性强、检测速度快,可用于快速检测鲍曼不动杆菌的耐药性。     

TaqMan MGB探针实时荧光定量PCR法检测幽门螺杆菌

目的建立TaqMan MGB探针实时荧光定量PCR快速检测幽门螺杆菌(HP)的方法。方法针对HP cagA基因设计特异性引物和探针,建立TaqMan MGB探针实时荧光定量PCR检测方法,并验证该方法的特异性、灵敏度和重复性。用该法对肝癌、肝硬化患者腹水及全血,猪、金黄地鼠、猴、犬、兔、豚鼠、大鼠、小鼠的全血、粪便、肠共1 201份标本进行检测,同时作常规细菌分离和测序分析。结果本方法特异性为100%,最低可检测2.2×101copies/μL的质粒DNA。标准曲线表明其具有良好线性关系,回归方程为:Y=-3.306X+38.633,相关系数(r)为0.999,扩增效率为100.648%。批内相对标准偏差(RSD)为0.19%～1.2%,批间RSD为0.14%～3.4%,RSD均<5%。上述1 201份标本用本法检出HP阳性130份,常规细菌分离法仅检出2份HP阳性。测序结果表明,与GenBank中收录的HP序列同源性为99%～100%。结论建立的TaqMan MGB探针实时荧光定量PCR法特异性和灵敏度高,重复性良好,适用于HP感染的检测。     

细菌革兰双检荧光定量PCR方法检测新生儿败血症

目的 建立细菌革兰阴、阳性菌双重实时荧光定量检测体系,探讨其检测败血症的临床应用价值.方法 分析细菌16SrRNA基因序列,在高度保守区自行设计通用引物和革兰阴性和阳性分型探针,选取临床较常见的35株菌株进行细菌革兰双检实时荧光定量PCR方法检测;对临床疑为败血症的512例新生患儿分别做细菌革兰双检荧光定量PCR和血培养检测.结果 细菌革兰双检荧光定量PCR具有较好的敏感性和特异性,能稳定检测到10 CFU左右细菌数.35株菌株进行细菌革兰双检荧光定量PCR检测,均为阳性,且革兰阴、阳性菌能正确分型和定量.巨细胞病毒、EB病毒、乙肝病毒、新型隐球菌及白色念珠菌、人基因组DNA及空白对照均为阴性.对临床疑为败血症的512份新生患儿标本中,革兰双检荧光定量PCR检测血标本阳性率8.20%(42/512),血培养阳性率6.25%(32/512),前者明显高于后者,差异具有统计学意义(χ<'2>=8.10,P<0.01),30例非感染性疾病同期患儿血标本革兰双检荧光定量PER及细菌培养均为阴性.若以血培养作为对照,细菌革兰双检荧光定量PCR方法的诊断敏感度为100%,特异度为97.92%,准确性98.05%.结论 建立了用通用引物和分型双荧光探针的细菌革兰双检荧光定量PER方法.其检测快速、准确,具有很大的临床推广价值.     

实时荧光定量PCR在快速检测耐甲氧西林金黄色葡萄球菌中的评价与应用

目的评价实时荧光定量聚合酶链反应(PCR)在快速检测耐甲氧西林金黄色葡萄球菌(MRSA)中的临床应用价值。方法经培养鉴定的70例已知细菌中22例为MRSA,48例为非MRSA,对已知细菌用实时荧光定量PCR进行检测,了解该方法的特异性和敏感性。对临床88例医护人员和患者的鼻拭子进行实时荧光定量PCR检测,了解医院内MRSA的携带情况。结果培养为MRSA,实时荧光定量PCR检测结果均为MRSA,敏感性为100%;培养为非MRSA,实时荧光定量PCR检测结果均为非MRSA,特异性为100%。实时荧光定量PCR检测MRSA的敏感性可确定为1×103cfu/mL。48例患者的鼻拭子mecA耐药基因阳性26例,金黄色葡萄球菌阳性28例,两者同时阳性(即为MRSA)20例,MRSA阳性检出率为41.6%;40例医护人员鼻拭子mecA耐药基因阳性12例,金黄色葡萄球菌阳性13例,两者同时阳性(即为MRSA)9例,MRSA阳性检出率为22.5%。结论实时荧光定量PCR可用于临床对MRSA的快速检测。     

实时荧光定量PCR检测人粪便中空肠弯曲杆菌方法的建立与评价

目的：建立一种快速检测人粪便样本中空肠弯曲杆菌的实时荧光定量 PCR方法。方法根据空肠弯曲杆菌保守序列设计特异引物,建立空肠弯曲杆菌的实时荧光定量 PCR检测法。对该方法的线性范围、抗干扰能力进行考察。同时采用培养法和实时荧光定量 PCR法对150例粪便样本进行检测,以培养法检测结果作为参照标准,对实时荧光定量 PCR方法的灵敏度、特异度、准确度和重复性进行考察。采用 Kappa检验对两种检测方法的结果进行统计学分析。结果建立的实时荧光定量PCR方法标准曲线线性关系良好Y＝-3.51 Log（X）＋37.09,相关系数为0.996,理论检测下限为102 CFU/ml。抗干扰能力强,仅空肠弯曲杆菌出现特异性扩增曲线。与培养法相比,其灵敏度、特异度、准确度分别为92.4％,95.8％和94％;检测结果重复性良好（CV％＜5％）。统计学分析显示两种方法检测结果具有一致性,且一致性强度为极强（Kappa＝0.88,P＜0.05）。结论实时荧光定量PCR法能准确快速检测粪便样品中的空肠弯曲杆菌。     

伯泰血培养瓶对细菌培养生长能力和敏感性分析

目的用已知细菌检测伯泰血培养瓶细菌培养生长能力。方法将已知细菌稀释成不同浓度,定量加入伯泰血培养瓶,观察细菌生长情况。结果需氧瓶对需氧菌的阳性检测率为100％,检测敏感性为10CFU／ml;厌氧瓶对厌氧菌的阳性检测率为100％,对黑色消化球菌、厌氧消化链球菌和脆弱类杆菌的检测敏感性分别为10CFU／ml、100CFU／ml和1000CFU／ml;厌氧瓶对兼性厌氧菌的阳性检测率为100％,检测敏感性为10CFU／ml。结论伯泰血培养瓶对需氧菌、厌氧菌及兼性厌氧菌的检测能力可以满足临床要求。     

Detection of bacteria in platelet concentrates: comparison of broad-range real-time 16S rDNA polymerase chain reaction and automated culturing

BACKGROUND: Based on real-time polymerase chain reaction (PCR) technology, a broad-range 16S rDNA assay was validated and its performance was compared to that of an automated culture system to determine its usefulness for rapid routine screening of platelet concentrates (PCs). STUDY DESIGN AND METHODS: The presence of bacteria in pooled PCs was routinely assessed in an automated culturing system (BacT/ALERT, bioMerieux). The PCR assay was performed with DNA extracted from the same samples as used for culturing. DNA extraction was performed with a automated extraction system (MagNA Pure, Roche Diagnostics). PCR amplification was performed with a set of universal primers and probe targeting eubacterial 16S rDNA. RESULTS: A total of 2146 PCs were tested. Eighteen (0.83%) samples were found to be contaminated. These samples were positive for the presence of bacteria by both methods. All contaminants were identified as bacteria belonging to the common human skin flora. These included Propionibacterium spp. (n = 7), Staphylococcus spp. (n = 6), Bacillus spp. (n = 2), Micrococcus spp. (n = 2), and Peptostreptococcus spp. (n = 1). Estimation of the bacterial load in PCs by real-time PCR showed that the initial levels of contamination varied between 13.6 and 9 x 10(4) colony-forming unit equivalents per PCR procedure. CONCLUSIONS: Compared to culture in the BacT/ALERT system, the PCR assay had a sensitivity of 100 percent and a specificity of 100 percent. This real-time PCR assay has a much shorter turnaround time of 4 hours, which offers the possibility to test and obtain results on PCs before release or the day they are transfused. This would permit the withdrawal of contaminated PCs before transfusion.     

全血中伤寒沙门菌RT-LAMP检测方法的建立

目的 建立反转录-环介导等温核酸扩增(RT-LAMP)方法特异检测伤寒沙门菌。 方法 针对伤寒沙门菌 fliC-d 基因设计6条特异性引物,通过优化反应条件,建立检测该靶基因的RT-LAMP方法,利用48个血清型的纯培养伤寒和非伤寒沙门菌菌株、常见非沙门致腹泻病原菌以及发热为主要症状的8种常见病原菌RNA评价该方法的特异性及敏感性,同时对伤寒沙门菌全血模拟标本进行敏感性检测,并与rRT-PCR方法的敏感性进行比较。 结果 等温65 ℃条件下,30~60 min内可完成RT-LAMP检测反应,利用该方法检测44株伤寒沙门菌均阳性,除4种少见的非伤寒沙门菌血清型扩增阳性外,其余30种非伤寒沙门菌血清型、致腹泻的其他5种肠道致病菌以及发热为主要症状的8种常见非沙门菌也均扩增阴性。在对纯菌总RNA检测中,RT-LAMP的最低检测限为0.5 pg/反应,即97个拷贝/反应。在以全血模拟样品提取核酸为模板的检测中,敏感性达1 cfu/ml,比rRT-PCR检测低限高100倍。 结论 建立了敏感性高、特异性好的RT-LAMP检测血液中伤寒沙门菌的方法,为伤寒沙门菌感染的快速诊断及不明原因发热症状的病原初步鉴别提供了简便的手段,可用于对伤寒的早期诊断、预防控制及临床治疗。     

Evaluation of a real-time fluorescent PCR assay for rapid detection of Group B Streptococci in neonatal blood

Streptococcus agalactiae (Group B Streptococcus: GBS) is the major causative agent of neonatal sepsis. Neonates at risk for GBS infections are empirically administered broad-spectrum antibiotics for at least 48 h pending blood culture results. A rapid assay to expedite detection of GBS would facilitate initiation of specific antibiotic therapy. Conversely, expeditious proof of absence of infection will avoid unnecessary antibiotic use. Using the LightCycler, we evaluated a hybridization probe polymerase chain reaction (PCR) assay to detect GBS-specific cfb gene target DNA sequence in blood specimens. Both sensitivity and specificity of the real-time PCR assay was 100%. The assay demonstrated 100% specificity when tested against 26 non-GBS bacteria. This method is capable of detecting as few as approximately 100 copies or 10 pg of GBS genomic DNA. This real-time PCR method is rapid, sensitive, and specific for the detection of GBS in neonatal blood samples and holds great promise in its utility in the diagnostic laboratory.     

食品中志贺活菌叠氮溴乙锭实时荧光聚合酶链反应技术研究

目的 利用叠氮溴乙锭（ethidium monoazide bromide,EMA）实时荧光聚合酶链反应（PCR）技术,建立一种简便、快速、特异、灵敏的在食品中检测志贺活菌的方法。方法 根据志贺菌ipaH基因保守序列设计特异性引物和探针。用不同EMA浓度、不同光照次数优化样品EMA前处理条件。用已知菌验证志贺活菌检测的敏感性和志贺死菌检测的抑制性。用31株志贺菌、26株单增李斯特菌、24株沙门菌、25株副溶血弧菌、11株阪崎肠杆菌、10株致病性大肠埃希菌和1株大肠埃希菌验证方法的特异性和稳定性。同时用本研究方法和常规分离培养法,对30件模拟样品进行实样验证。结果 志贺活菌EMA实时荧光PCR方法的循环阈值（Ct）=32.10~3.19log（菌量）（R2=0.994）。最低检测浓度为2.20 CFU/反应。对死菌DNA抑制效率99.97%。31株志贺菌Ct值最低为15.04,最高为26.54,而97株非志贺菌的Ct值均35或无Ct值（呈一条直线）。重复试验Ct值变异系数3。30件模拟样品采用本研究方法和常规分离培养法的检测结果一致,但采用EMA实时荧光PCR方法耗时不超过7.5 h,而常规分离培养方法则需要3～5 d。结论 EMA实时荧光PCR技术是一种快速简便、特异性强、灵敏度高、仅检测志贺活菌的方法,建议在食品检测中推广应用。     

实时荧光PCR分子信标检测耐利福平结核分枝杆菌印rpoB基因

目的 应用实时荧光PCR分子信标技术,建立快速检测临床标本中结核分枝杆菌利福平rpoB相关耐药突变点方法,探讨其缩短耐药实验报告时间的临床应用价值.方法 以分枝杆菌药物敏感性实验绝对浓度法为标准,12株非结核分枝杆菌、4株非分枝杆菌作对照,对174例结核患者临床分离株应用实时荧光PCR分子信标方法,检测利福平rpoB核心区域的耐药突变点并将结果与直接测序进行比较.结果 (1)实时荧光PCR分子信标方法:82例结核分枝杆菌利福平敏感菌株中,3例发生rpoB基因突变,特异度为96.3%;92例结核分枝杆菌利福平耐药菌株中,82例检出耐药突变,敏感度为89.1%;准确性为92.5%.(2)DNA直接测序分析:82例结核分枝杆菌利福平敏感株中,1例发生rpoB基因突变,特异度为98.8%;92例结核分枝杆菌利福平耐药菌株中,83例发生:rpoB基因突变,敏感度为90.2%;准确性为94.2%.检测174株结核分枝杆菌临床分离菌株,与实时荧光PCR分子信标方法检测一致性为98.3%(171/174).结论 实时荧光PCR分子信标方法检测耐利福平结核分枝杆菌rpoB基因突变点可作为结核患者快速耐药检测的初筛方法之一.     

The performance of the BD geneOhm MRSA™ assay for MRSA isolated from clinical patients in Japan,including the effects of specimen contamination and ways to improve it

The BD geneOhm MRSA™ assay has been increasingly used in recent years, and it is possible to use it to screen and detect methicillin-resistant Staphylococcus aureus (MRSA) from a specimen within 2 h. The purpose of the present study was to evaluate the performance, i.e., the specificity and sensitivity, of the BD geneOhm MRSA™ assay to detect MRSA. Its specificity was assessed to be 100% compared to bacterial culture methods, which are commonly used in medical laboratories. Its bacterial limit of detection was over 10 colony-forming units (cfu) per reaction, although MRSA was detected at a cfu below 10 per reaction in a few samples. Additionally, the effect of MRSA isolate contamination was examined. While contamination with protein or other bacteria did not affect the outcome, contamination with a high concentration of blood resulted in an unresolved outcome. To inactivate polymerase chain reaction (PCR) inhibitors, the DNA samples were freeze–thawed prior to the BD geneOhm MRSA™ assay, which led to the sensitivity of the assay increasing. In summary, the BD geneOhm MRSA™ assay is rapid and shows high specificity and sensitivity of cultured MRSA isolates. It will, therefore, be a valuable diagnostic tool for detecting MRSA in specimens from clinical patients.     

Duplex real-time PCR assay for rapid detection of ampicillin-resistant Enterococcus faecium

Rapid and accurate identification of carriers of resistant microorganisms is an important aspect of efficient infection control in hospitals. Traditional identification methods of antibiotic-resistant bacteria usually take at least 3 to 4 days after sampling. A duplex real-time PCR assay was developed for rapid detection of ampicillin-resistant Enterococcus faecium (ARE). Primers and probes that are used in this assay specifically detected the D-Ala-D-Ala ligase gene of E. faecium and the modified penicillin-binding protein 5 gene (pbp5) carrying the Glu-to-Val substitution at position 629 (Val-629) in a set of 129 tested E. faecium strains with known pbp5 sequence. Presence of the Val-629 in the strain set from 11 different countries was highly correlated with ampicillin resistance. In a screening of hospitalized patients, the real-time PCR assay yielded a sensitivity and a specificity for the detection of ARE colonization of 95% and 100%, respectively. The results were obtained 4 h after samples were harvested from overnight broth of rectal swab samples, identifying both species and the resistance marker mutation in pbp5. This novel assay reliably identifies ARE 2 to 3 days more quickly than traditional culture methods, thereby increasing laboratory throughput, making it useful for rectal screening of ARE. The assay demonstrates the advantages of real-time PCR for detection of nosocomial pathogens.     

海洋创伤弧菌LAMP快速诊断方法的建立与评价

目的利用环介导等温扩增(LAMP)技术,建立海洋创伤弧菌快速、简便、特异且敏感的检测方法,并对该方法的特异性和灵敏度进行评价。方法选取海洋创伤弧菌溶细胞素(vvhA)基因作为靶基因,根据GenBank公布的序列设计4条LAMP引物;对47株细菌(包括20株弧菌属细菌)进行LAMP和聚合酶链式反应(PCR)扩增,并做特异性比较;对创伤弧菌M06株增菌液10倍倍比稀释,提取DNA后进行灵敏度的检测,并与常规PCR作比较;构建含vvhA基因片段的重组质粒,作为LAMP反应体系的标准阳性对照。结果常规PCR实验出现假阳性结果,而LAMP实验只有海洋创伤弧菌出现阳性扩增,其他样品均为阴性,无假阳性和假阴性结果,表明引物的特异性较好,加入钙黄绿素和电泳结果相一致;针对vvhA基因建立的LAMP技术其最低检测下限为每个反应4×10CFU,是常规PCR(每个反应4×10~2 CFU)的10倍,呈现较好的灵敏度。重复实验过程两遍,PCR和LAMP技术检测结果稳定。结论建立了一种用于检测海洋创伤弧菌的LAMP检测方法,该方法特异性强,灵敏度高,方便快捷,特别适合用于现场和床旁的快速检测。     

空肠弯曲菌 TaqMan-MGB双重探针实时荧光定量 PCR快速检测

目的　开发一种特异、灵敏的TaqMan MGB 双重探针实时荧光定量PCR 方法,用于空肠弯曲菌的快速定量检 测。方法　针对空肠弯曲菌鞭毛蛋白A 和马尿酸酶基因设计特异性引物和探针,建立一种新型TaqMan-MGB 双重探针 实时荧光定量PCR 检测空肠弯曲菌方法,对该方法的定量检测线性范围、特异度、灵敏度、重复性、稳定性进行评价, 应用该方法对临床标本中的空肠弯曲菌进行检测,同时用细菌培养、普通PCR、基因克隆和测序鉴定。结果　建立的 空肠弯曲菌TaqMan MGB 双重探针实时荧光定量PCR 检测方法专属性强,能准确检出空肠弯曲菌,而与其他细菌无交 叉反应,特异度为100%。该技术灵敏度高,能精确定量检测空肠弯曲菌DNA 线性范围达10 个数量级,最低检测限为 4 个菌落形成单位。重复性和稳定性良好,组内和组间相对标准偏差均小于1%。应用该方法成功从78 例临床标本中定 量检出28 例空肠弯曲菌阳性标本,用普通PCR 和基因克隆测序分析确认,细菌培养方法仅获得6 株存活的空肠弯曲菌。 结论　TaqMan MGB 双重探针实时荧光定量PCR 具有快速简便、可靠稳定、特异灵敏的优点,可用于临床标本中空肠 弯曲菌定量检测,值得推广应用。