三种常用检测肺炎克雷伯菌超广谱β-内酰胺酶方法的分析与研究  

Analysis and study on the three methods commonly used for detection of the hyperspectral β-lactamase in Klebsiella pneumoniae

作　　者：徐艳霞 梁璐 陈建丽 倪佳 

机构地区：[1]贵州省妇幼保健院急诊-儿童重症医学科,贵州贵阳550003 [2]贵州省妇幼保健院临床微生物室,贵州贵阳550003

出　　处：《贵州医药》2018年第1期18-21,共4页Guizhou Medical Journal

基　　金：贵州省科技厅联合基金[黔科合LH(2014)7298号]

摘　　要：目的评估三种检测产ESBLs肺炎克雷伯菌株常用方法的可靠性。方法选取2014年9月至2016年12月从收集三家医院PICU住院患儿深部痰液、血液、胸腹腔积液、创面分泌物等标本,排除同一患者同一部位重复分离的标本,分离非重复肺炎克雷伯菌207株。分别采用双纸片法、改良三维试验和自动仪器VITEK 2Compact,对分离菌株进行ESBLs检测。检测结果采用SPSS19.0软件进行统计和分析,两种方法之间不一致部分采用McNemarχ~2检验,用Kappa检验两种检测结果之间是否有一致性,P<0.05为差异有统计学意义。结果双纸片法、自动仪器法和改良三维试验ESBLs检出率分别是58.5%(121/207)、61.4%(127/207)和66.7%(138/207)。对三种方法检测结果进行两两间一致性检验,提示一致性较好(K>0.4,P<0.05))。双纸片法与自动仪器法检测结果中不一致部分之间的差异无统计学意义(P>0.05);改良三维试验与双纸片法检测结果中不一致部分之间的差异有统计学意义(P<0.05),改良三维试验的检出率高于双纸片法;改良三维试验与自动仪器法检测结果中不一致部分之间的差异有统计学意义(P<0.05),改良三维试验的检出率高于自动仪器法。结论纸片法和自动仪器法具有操作快速简便、结果可靠的特点,适合于临床微生物实验室常规开展检测ESBLs;改良三维试验可扩大ESBLs产酶菌株的检测范围,对表型试验起到重要补充作用。Objective To evaluate the reliability of three methods for the detection of ESBLs-producing Klebsiella pneumoniae strains.Methods From September 2009 to December 2016,it was collected the specimens of deep sputum,blood,pleural effusion and wound secretions in children with PICU from three hospitals,excluding the specimen that belongs to the same patient and same body parts and separated from non-repeating pneumonia 207 strains of Klebsiella.The ESBLs in separated strains were detected by double-disk diffusion test,modified three-dimensional test and automatic instrument VITEK 2 Compact,and the results were analyzed by SPSS19.0 software.The inconsistent part of the two methods was tested by McNemarX2 test.Meanwhile,the consistency between the two test results was detected by Kappa test.Results The detection rate of ESBLs was 58.5%（121/207）,61.4%（127/207）and 66.7%（138/207）,respectively through the above three methods.Two coincidence tests were performed on the results of the three methods,suggesting a better consistency（К0.4,P〈0.05）.By comparing the experimental results,the inconsistent part detected by double-disk diffusion test and automatic instrument VITEK 2 Compact there were no statistical significantly differences（P〈0.05）,while the inconsistent part detected by modified three-dimensional test and double-disk diffusion test there were statistical significantly differences.The detection rate of the modified three-dimensional test was not only higher than that of the double-disc method,but also than that of the automatic instrument method.The inconsistent part detected by the improved three-dimensional test and the automatic test method were statistical significantly differences（P〈0.05）.Conclusion The double-disk diffusion test and automatic instrument tests are easy to operate and reliable,which is suitable for the routine detection of ESBLs in clinical microbiology laboratory.The improved three-dimensional test can expand the detection range of ESBLs-producing strains,and can be

关 键 词：双纸片法 VITEK2 改良三维试验 超广谱Β-内酰胺酶 

分 类 号：R378[医药卫生—病原生物学] R446.5[医药卫生—基础医学]