抑制剂增强碳青霉烯类灭活法对革兰阴性杆菌碳青霉烯酶初步分类的评价  

Evaluation on the preliminary classification of carbapenemase in gram-negative rods by the inhibitor enhanced carbapenem inactivation method

作　　者：孙青阳[1] 杨燕[1] 韦文君 林迪 陈坚[1] 曾贤铭[1] 成军[1] 孙长贵[1] 

机构地区：[1]解放军第一一七医院检验科,杭州310013

出　　处：《临床检验杂志》2018年第1期14-18,共5页Chinese Journal of Clinical Laboratory Science

基　　金：南京军区医学科技创新重点课题(10Z037)

摘　　要：目的评价抑制剂增强碳青霉烯类灭活法(ieCIM)对革兰阴性杆菌碳青霉烯酶检测及初步分类的可靠性。方法分别以他唑巴坦和乙二胺四乙酸作为碳青霉烯酶抑制剂,对CIM进行改良。选取临床分离的198株肠杆菌科细菌和35株非发酵菌,采用ieCIM检测碳青霉烯酶并进行初步分类,以PCR方法检测碳青霉烯酶基因作对比。结果 198株肠杆菌科细菌中碳青霉烯酶基因阳性101株,CIM检测阳性99株;碳青霉烯酶基因阴性97株,CIM检测均阴性。35株非发酵菌中碳青霉烯酶基因阳性25株,CIM检测阳性24株;碳青霉烯酶基因阴性10株,CIM检测均阴性。使用ieCIM初步分类碳青霉烯酶,87株产A类酶菌株中检出85株(97.7%),25株产B类酶菌株中检出22株(88.0%),12株产D类酶菌株和2株同时产A、B类酶菌株全部检出,ieCIM检测敏感性为96%,特异性100%。结论 ieCIM与基因检测结果一致性高,适合临床微生物常规工作中对碳青霉烯酶的检测及初步分类。Objective To evaluate the reliability of the inhibitor enhanced carbapenem inactivation method （ieCIM） in the detection and preliminary classification of carbapenemase in gram-negative rods. Methods The carbapenem inactivation method （ CIM ） was modified by adding tazobactam or ethylene diamine tetraacetic acid disodium sah as carbapenemase inhibitors into the reaction system. A total of 198 isolates of Enterobacteriaceae and 35 strains of nonfermenters were collected, and their preliminary classification of car- bapenemase was performed by the ieCIM. Meanwhile, their carbapenemase genes were detected by polymerase chain reaction （PCR）, and the results were compared with that of the ieCIM. Results Among 198 strains of Enterobacteriaceae, 101 were positive for carbap- enemase genes, while 99 were detected by the CIM. Among the other 97 strains with negative earbapenemase gene, the results of the ieCIM were also negative. Among 35 strains of nonfermenters, 25 were positive for carbapenemase genes, while 24 were detected by the CIM. Among the other 10 strains with negative carbapenemase gene, the results of the CIM were also negative. Using the ieCIM, 97.7% （85/87） of strains producing class A carbapenemase and 88.0% （22/25） of strains producing class B carbapenemase were detected. Twelve strains producing class D carbapenemase and 2 strains producing both class A and class B carbapenemase were detec- ted by the ieCIM. The total detection sensitivity and specificity of the ieCIM were 96% and 100%, respectively. Conclusion The ieCIM has the consistent results with the detection method of earbapenemase genes, which may be used to detect and classify carbapen- emase in clinical microbiology laboratories.

关 键 词：碳青霉烯灭活法 碳青霉烯酶 肠杆菌科 

分 类 号：R446.5[医药卫生—诊断学]