四、總結與展望
MALDI-TOF
MS是一種簡單、快速、高通量和高效的微生物鑒定手段, 在臨床樣本直接檢測方面較傳統的鑒定方法具有更大的優勢,
能顯著降低樣本檢測的周轉時間和成本, 但尚存在著一些不足之處, 主要表現在:(1)MALDI-TOF MS在檢測和鑒定細菌方面的敏感性還不高,
不能直接鑒定患者血樣本中的病原菌(細菌數量太少); (2)對于一些核糖體蛋白差異較小的細菌用其辨別有較大的困難;
(3)目前的研究都有各自不同的操作過程, 在樣本處理、質譜圖采集和分析等方面沒有統一的標準, 可能會影響分析結果在實驗室內和實驗室間的可重復性;
(4)標準的鑒定參考圖譜數據庫尚不夠完善, 需要進一步拓展;
(5)對一些細胞壁難以破壞的細菌(如革蘭陽性菌、酵母菌)和混合菌等的鑒定能力還不夠高。但是相信隨著更加有效的樣本預處理方法、更加嚴格的檢測過程控制和更高分辨率的圖像處理技術的實現,
MALDI-TOF MS用于直接檢測臨床樣本中的微生物會有更廣闊的前景。
參考文獻
[1] ANHALT JP. Identification of bacteria using mass spectrometry[J]. Analytical Chemistry, 1975, 47(2): 219-225.
[2]
CROXATTO A, PROD'HOM G, GREUB G. Applications of MALDI-TOF mass
spectrometry in clinical diagnostic microbiology[J]. FEMS Microbiol Rev,
2012, 36(2): 380-407.
[3]
PATEL R. MALDI-TOF mass spectrometry: transformative proteomics for
clinical microbiology[J]. Clin Chem, 2013, 59(2): 340-342.
[4]
WANG MC, LIN WH, YAN JJ, et al. Early identification of microorganisms
in blood culture prior to the detection of a positive signal in the
BACTEC FX system using matrix-assisted laser desorption/ionization-time
of flight mass spectrometry[J]. J Microbiol Immunol Infect, 2013. [Epub
ahead of print]
[5] NonNEMANN
B, TVEDE M, BJARNSHOLT T. Identification of pathogenic microorganisms
directly from positive blood vials by matrix-assisted laser
desorption/ionization time of flight mass spectrometry[J]. APMIS, 2013, 121(9): 871-877.
[6]
HAMMARSTR?M B, NILSON B, LAURELL T, et al. Acoustic trapping for
bacteria identification in positive blood cultures with MALDI-TOF MS[J].
Anal Chem, 2014, 86(21): 10560-10567.
[7]
FERREIRA L, SáNCHEZ-JUANES F, GONZáLEZ-AVILA M, et al. Direct
identification of urinary tract pathogens from urine samples by
matrix-assisted laser desorption ionization-time of flight mass
spectrometry[J]. J Clin Microbiol, 2010, 48(6): 2110-2115.
[8]
K?HLING HL, BITTNER A, MüLLER KD, et al. Direct identification of
bacteria in urine samples by matrix-assisted laser desorption/ionization
time-of-flight mass spectrometry and relevance of defensins as
interfering factors[J]. J Med Microbiol, 2012, 61(Pt 3): 339-344.
[9] BADER O. MALDI-TOF-MS-based species identification and typing approaches in medical mycology[J]. Proteomics, 2013, 13(5): 788-799.
[10]
STEVENSON LG, DRAKE SK, MURRAY PR. Rapid identification of bacteria in
positive blood culture broths by matrix-assisted laser desorption
ionization-time of flight mass spectrometry[J]. J Clin Microbiol, 2010,
48(2): 444-447.
[11]
LA SCOLA B, RAOULT D. Direct identification of bacteria in positive
blood culture bottles by matrix-assisted laser desorption ionisation time-of-flight mass spectrometry[J]. PLoS One, 2009, 4(11): e8041.
[12] MARCH ROSSELLó GA, GUTIéRREZ RODRíGUEZ MP, ORTIZ DE LEJARAZU LEonARDO
R, et al. New procedure for rapid identification of microorganisms
causing urinary tract infection from urine samples by mass spectrometry
(MALDI-TOF)[J]. Enferm Infecc Microbiol Clin, 2015, 33(2): 89-94.
[13]
GORTON RL, RAMNARAIN P, BARKER K, et al. Comparative analysis of Gram's
stain, PNA-FISH and Sepsityper with MALDI-TOF MS for the identification
of yeast direct from positive blood cultures[J]. Mycoses, 2014, 57(10):
592-601.
[14] VLEK AL, BonTEN MJ, BOEL CH. Direct matrix-assisted laser desorption ionization
time-of-flight mass spectrometry improves appropriateness of antibiotic
treatment of bacteremia[J]. PLoS One, 2012, 7(3): e32589.
[15] CLERC O, PROD'HOM G, VOGNE C, et al. Impact of matrix-assisted laser desorption ionization
time-of-flight mass spectrometry on the clinical management of patients
with Gram-negative bacteremia: a prospective observational study[J]. Clin Infect Dis, 2013, 56(8): 1101-1107.
[16]
YAN Y, HE Y, MAIER T, et al. Improved identification of yeast species
directly from positive blood culture media by combining Sepsityper
specimen processing and Microflex analysis with the matrix-assisted
laser desorption ionization Biotyper system[J]. J Clin Microbiol, 2011, 49(7): 2528-2532.
[17]
PROD'HOM G, BIZZINI A, DURUSSEL C, et al. Matrix-assisted laser
desorption ionization-time of flight mass spectrometry for direct
bacterial identification from positive blood culture pellets[J]. J Clin
Microbiol, 2010, 48(4): 1481-1483.
[18]
FERRONI A, SUAREZ S, BERETTI JL, et al. Real-time identification of
bacteria and Cand ida species in positive blood culture broths by
matrix-assisted laser desorption ionization-time of flight mass
spectrometry[J]. J Clin Microbiol, 2010, 48(5): 1542-1548.
[19]
SCHMIDT V, JAROSCH A, M?RZ P, et al. Rapid identification of bacteria
in positive blood culture by matrix-assisted laser desorption ionization time-of-flight mass spectrometry[J]. Eur J Clin Microbiol Infect Dis, 2012, 31(3): 311-317.
[20]
SCHUBERT S, WEINERT K, WAGNER C, et al. Novel, improved sample
preparation for rapid, direct identification from positive blood
cultures using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry[J]. J Mol Diagn, 2011, 13(6): 701-706.
[21] 陳峰, 李媛睿, 皇甫昱嬋, 等. 分離膠促凝管聯合MALDI-TOF MS直接檢測血培養陽性細菌[J]. 檢驗醫學, 2015, 30(2): 113-121.
[22]
PAOLUCCI M, FOSCHI C, TAMBURINI MV, et al. Comparison between MALDI-TOF
MS and FilmArray Blood Culture Identification panel for rapid
identification of yeast from positive blood culture[J]. J Microbiol
Methods, 2014, 104: 92-93.
[23]
KROUMOVA V, GOBBATO E, BASSO E, et al. Direct identification of
bacteria in blood culture by matrix-assisted laser desorption/ionization
time-of-flight mass spectrometry: a new methodological approach[J].
Rapid Commun Mass Spectrom, 2011, 25(15): 2247-2249.
[24]
IDELEVICH EA, SCHüLE I, GRüNASTEL B, et al. Rapid identification of
microorganisms from positive blood cultures by MALDI-TOF mass
spectrometry subsequent to very short-term incubation on solid
medium[J]. Clin Microbiol Infect, 2014, 20(10): 1001-1006.
[25]
HONG SK, CHANG BK, SONG SH, et al. Use of MALDI-TOF MS technique for
rapid identification of bacteria from positive blood cultures[J]. Indian
J Med Microbiol, 2014, 32(4): 419-422.
[26]
MACHEN A, DRAKE T, WANG YF. Same day identification and full panel
antimicrobial susceptibility testing of bacteria from positive blood
culture bottles made possible by a combined lysis-filtration method with
MALDI-TOF VITEK mass spectrometry and the VITEK2 system[J]. PLoS One,
2014, 9(2): e87870.
[27]
PEREZ KK, OLSEN RJ, MUSICK WL, et al. Integrating rapid pathogen
identification and antimicrobial stewardship significantly decreases
hospital costs[J]. Arch Pathol Lab Med, 2013, 137(9): 1247-1254.
[28] SZABADOS F, MICHELS M, KAASE M, et al. The sensitivity of direct identification from positive BacT/alertTM (bioMérieux) blood culture bottles by matrix-assisted laser desorption ionization time-of-flight mass spectrometry is low[J]. Clin Microbiol Infect, 2011, 17(2): 192-195.
[29]
ROMERO-GóMEZ M P, MINGORANCE J. The effect of the blood culture bottle
type in the rate of direct identification from positive cultures by
matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) mass spectrometry[J]. J Infect, 2011, 62(3): 251-253.
[30]
SáNCHEZ-JUANES F, SILLER RUIZ M, MORENO OBREGON F, et al. Pretreatment
of urine samples with SDS improves direct identification of urinary
tract pathogens with matrix-assisted laser desorption ionization-time of
flight mass spectrometry[J]. J Clin Microbiol, 2013, 52(1): 335-338.
[31]
DEMARCO ML, BURNHAM CA. Diafiltration MALDI-TOF mass spectrometry
method for culture-independent detection and identification of pathogens
directly from urine specimens[J]. Am J Clin Pathol, 2014, 141(2):
204-212.
[32]
LEE TF, LEE H, CHEN CM, et al. Comparison of the accuracy of
matrix-assisted laser desorption ionization-time of flight mass
spectrometry with that of other commercial identification systems for
identifying Staphylococcus saprophyticus in urine[J]. J Clin Microbiol,
2013, 51(5): 1563-1566.
[33] 楊溪, 王新華, 隋文君, 等. MALDI-TOF MS直接鑒定原始尿液中的病原菌[J]. 中華檢驗醫學雜志, 2013, 36(11): 1042-1044.
[34] MARCH ROSSELLó GA, GUTIéRREZ RODRíGUEZ MP, DE LEJARAZU LEonARDO RO, et al. Procedure for microbial identification based
on matrix-assisted laser desorption/ionization-time of flight mass
spectrometry from screening-positive urine samples[J]. APMIS, 2014,
122(9): 790-795.
[35]
WANG XH, ZHANG G, FAN YY, et al. Direct identification of bacteria
causing urinary tract infections by combining matrix-assisted laser
desorption ionization-time of flight mass spectrometry with UF-1000i
urine flow cytometry[J]. J Microbiol Methods, 2013, 92(3): 231-235.
[36] 王琳, 李佳萍, 陳功祥, 等. MALDI-TOF MS在中段尿樣本細菌直接檢測中的應用[J]. 檢驗醫學, 2015, 30(2): 108-112.
[37]
NYVANG HARTMEYER G, KVISTHOLM JENSEN A, B?CHER S, et al. Mass
spectrometry: pneumococcal meningitis verified and Brucella species
identified in less than half an hour[J]. Scand J Infect Dis, 2010,
42(9): 716-718.
[38]
SEGAWA S, SAWAI S, MURATA S, et al. Direct application of MALDI-TOF
mass spectrometry to cerebrospinal fluid for rapid pathogen
identification in a patient with bacterial meningitis[J]. Clin Chim
Acta, 2014, 435: 59-61.