Application Value Analysis of Morphological Examination Combined with MALDI-TOF MS Technology in the Early Identification of Pathogenic Bacteria in Bloodstream Infection/LIJiequn，YU Jinggui，WANG Hengmin.//Medical Innovation of China，2025，22（18）： 153-157

[Abstract]Objective：To analyze the application value of morphological examinationcombined with matrixassisted laser desorption/ionization time-of-flight massspectrometry （MALDI-TOF MS） technology in the early identification of pathogenic bacteria in bloodstream infection.Method：Aretrospective analysis was conductedon the clinical dataof12O patients with bloodstream infectionadmited tothe SecondPeople's Hospitalof Jingdezhen fromApril to December 2O24.Taking the biochemical identification of coloniesafter transplantation of positive blood culture specimens as the gold standard，the identification time and accuracy of rapid mass spectrometry identification of positive blood culture specimens， morphological examination combined with MALDI-TOF MS technology were compared.Result： Among the12O patients with bloodstream infection，42 cases （35.00 % ）were Gram-positivebacteria and 78 cases （65.00% ）wereGram-negative bacteria.Comparisonof identification timefor different detection methods： rapid mass spectrometry identification lt; morphological examination combined with MALDI-TOF MS technology lt; biochemical identification of cultured colonies after transplanting，the difference was statistically significant （ P lt;0.05）. The accuracy rate of pathogen identification by morphological examination combined with MALDI-TOF MS technology was higher than that by rapid mass spectrometry identification， the difference was statistically significant （ P lt;0.05）. The identification accuracy rate of pure colonies of Gram-positive bacteria by morphological examination combined with MALDI-TOF MS technology was 97.62% ，and that of pure colonies of Gram-negative bacteria was 94.87%.Conclusion： Morphological examination combined with MALDITOF MS technology has high accuracy rate and rapid detection in theearly identificationof pathogenic bacteria in bloodstreaminfection，and itissuitable for earlydiagnosisand targeteddrug treatmentof patients with bloodstream infection.

[Key Words] Morphological examinationMatrix-assisted laser desorption/ionization time-of-flight mass spectrometry technology Bloodstream infection Pathogenic bacteria identification

First-author'saddress：Department of Laboratory Medicine，the Second People's Hospital of lingdezhen，Jingdezhen3330oo，China doi：10.3969/j.issn.1674-4985.2025.18.035

血流感染病情危重、病死率高，属病原菌入侵而出现的全身性感染疾病，临床多使用抗感染治疗为主[]。但随着近年来抗生素的广泛应用，耐药菌株持续增加，血流感染发病率也呈现逐年增高趋势[2。在血流感染患者确诊后，鉴定并获取病原菌种、属类型是保证药物治疗效果的基础，以往多采取传统生化鉴定方法，先行血培养确定为阳性，再行病原菌鉴定及药敏检测，以选择对应抗生素治疗[3。但由于其培养、鉴别时间较长，此时患者病情变化凶险，不利于临床早期治疗，故寻找更有高效的病原菌鉴定方法成为临床研究方向之二 [4]。基质辅助激光解吸电离飞行时间质谱（matrix-assisted laser desorption ionization time-of-flight massspectrometry，MALDI-TOFMS）技术是一种应用较为广泛的微生物鉴定方法，通过利用激光照射解吸电离技术和基质共结晶体，促使病原体核糖体蛋白离子化，后在电场中可获取其蛋白质图谱，与参考质谱对照比较后可确定病原菌种类[5。在技术层面可有效弥补传统生化鉴定的不足，具有简便、快速、低成本等优点，目前该技术可准确鉴定分离提纯后单菌落情况[。现有医疗工作者提出，对于血流感染患者，先通过革兰染色确定病原菌形态，再通过MALDI-TOFMS技术直接快速检测临床血培养报阳样本，不需要分离提纯，也可获取其病原菌类型和种属信息，更有利于病原菌早期鉴定和药物治疗，但在其鉴别准确度上暂无统一共识[7-8]。对此，本研究为分析形态学检查联合MALDI-TOFMS技术在血流感染病原菌早期鉴定中的应用价值，现有报道如下。……