評估使用血液培養系統及質譜儀之體液培養陽性率及檢驗時效

Efficacy Evaluation of Blood Culture System Combined with Mass Spectrometer to Improve Positive Rate and Turnaround Time in Body Fluid Samples

在臨床檢體中對於體液的培養關係著嚴重細菌感染病人的生命安危，因此腹膜透析液（Dialysate；DIA）、胸膜腔液（Pleural effusion；PL）及關節液（Synovial fluid；SY）的培養均屬於高致命性細菌感染症所必要之檢驗作業，若能正確且快速完成報告，應可有效協助臨床及時診斷與治療，對於病人安全更是一大助益。在臨床檢驗中，收集各項臨床檢體，分別為腹膜透析液110個案數、胸膜腔液110個案數以及關節液42個案數，對於此三類檢體，同時進行傳統方法與新方法比較，新方法是藉由血液培養系統及質譜儀直接鑑定，藉以提升培養陽性率與細菌鑑定時效，研究結果顯示，在培養陽性率上，關節液培養陽性率效能提升近66.4％，胸膜腔液培養陽性率效能提升45.0％，腹膜透析液則無顯著差異；在鑑定時效上，各項檢體別均顯示具有顯著差異，P值分別為p<0.0001（DIA）、p=0.0005（PL）及p=0.006（SY）。整體而言對於體液培養的新方法相較於傳統方法平均可大幅縮短39小時，相信新方法可提供臨床醫師更及時的診斷與治療依據。 The efficacy of culture of samples from body fluids for dialysate(DIA), pleural effusion(PL), and synovial fluid(SY) is crucial to clinical diagnosis and treatment. Therefore, how to effectively enhance the body fluid culture rate and shorten turnaround time (TAT) is essential for microbial laboratory. In this study, we aim to evaluate a new approach of direct identification of pathogens from blood culture, combined use of mass spectrometer (MALDI-TOF). Results obtained from this study indicated that, in contrast to culture, positive identification rate on synovial fluid and pleural effusion increased by 66.4%, and 45.0%, respectively. By contrast, there was no significant difference in dialysate samples. In the TAT, The P values were p < 0.0001 (DIA), p = 0.0005 (PL) and p = 0.006 (SY), respectively. Overall, the new method can significantly shorten the TAT to about 25 hours, compared to the conventional method of 64 hours. The new approach can provide a more timely diagnosis and treatment approach.