分子診斷技術(shù)在感控中的應用

1、分子診斷技術(shù)在感控中的應用分子生物學診斷技術(shù)檢測DNA、RNA或蛋白質(zhì)等物質(zhì)對疾病進行診斷或 輔助診斷分析基因或蛋白的存在、變異或表達為疾病提供更直接的證據(jù)常見分子診斷技術(shù)核酸檢測核酸擴增技術(shù)測序技術(shù)核酸雜交技術(shù)基因芯片技術(shù)生物傳感技術(shù)蛋白質(zhì)檢測光譜技術(shù)蛋白芯片技術(shù)標記免疫分析技術(shù)質(zhì)譜技術(shù)醫(yī)院感染暴發(fā)調(diào)查Sivertsen A, Billstrom H, Melefors O , Liljequist BO, Wisell KT, et al. (2014) A Multicentre Hospital Outbreak in Sweden Caused by Introduction of

2、a vanB2 Transposon into a Stably Maintained pRUM-Plasmid in an Enterococcus faecium ST192 Clone. PLoS ONE 9(8): e103274. doi:10.1371/journal.pone.0103274屎腸球菌ST192Baier et al. Molecular characteristics and successful management of a respiratory syncytial virus outbreak among pediatric patients with h

3、emato-oncological disease Antimicrobial Resistance and Infection Control (2018) 7:21RSV感染 暴發(fā)Sanger測序病原體診斷關(guān)于測序技術(shù)Sanger測序新一代測序（next genome sequencing, NGS）第三代測序genome-wide association study, GWASwhole-genome sequencing ,WGS耐藥基因/耐藥突變葡萄球菌：mecA、SCCmec腸球菌：VanA、 VanB、 VanC結(jié)核分枝桿菌：ropB腸桿菌科：NDM-1、KPC、 mcr-1HB

4、V、HCV、HIVCRE：CPE？NO-CP-CRE?孔蛋白缺失+ 產(chǎn)ESBL / AmpC水解厄他培南臨床反應可能與MIC一 致較低的傳播可能產(chǎn)碳青霉烯酶（如KPC，NDM）可能是交叉耐藥較高的暴發(fā)可能緊急感染控制Zhan L, et al.(2017) Outbreak by Hypermucoviscous Klebsiella pneumoniae ST11 Isolates with Carbapenem Resistance in a Tertiary Hospital in China. Front. Cell. Infect. Microbiol. 7:182. doi: 10

5、.3389/fcimb.2017.00182多種技術(shù)聯(lián)合應用PFGEPCR擴增測序血清分型MLST從經(jīng)驗治療到直接干預快速：24小時內(nèi)報告分子診斷實驗結(jié)果質(zhì)譜（MALDI-TOF）核酸擴增/檢測（NAAT）：多重PCR、微陣列（mecA, vanA, KPC； MRSA/SA, carbapenemases,C difficile）PNA-FISH（Enterococcus, Candida, Staphylococcus, EC/PSA/KP，mecA）T2MR： 用核磁信號檢測，目前僅用于念 珠菌二代測序：宏基因組學，但不快！ 全自動顯微鏡+ FISH：快速表型檢測Adapted from

6、 Chan, et al. Nature Biotechnology 30:1068-71CLSI AST News Update.2018,3(1).技術(shù)的局限性表型診斷實驗（MIC）與臨床結(jié)果非常相關(guān)MIC升高，耐藥基因表達任何微生物實驗室都可 以使用這種方法基因型診斷實驗（機制）更好地預測傳播風險和 暴發(fā)可能表型方法差（例如MHTNAAT僅在參考/研究實 驗室中可用納入醫(yī)院感染實時監(jiān)測和暴發(fā)預警系統(tǒng)Du et al.: Real-time automatic hospital-wide surveillance of nosocomial infections and outbreaks in a large Chinese tertiary hospital. BMC Medical Informatics a