MHT和mCIM试验检测肠杆菌科金属碳青霉烯酶效能的评价  

Evaluation on MHT and mCIM for detection of carbapenemase in Enterobacteriaceae

作　　者：宫雪 张晓丽[2] 王宇超[2] 苏珊珊 王晓红[2] 郭宇航[2] 李慧玲[2] 王勇[2] GONG Xue;ZHANG Xiaoli;WANG Yuchao;SU Shanshan;WANG Xiaohong;GUO Yuhang;LI Huiling;WANG Yong(Jiamusi University,Jiamusi,Heilongjiang 154007,China)

机构地区：[1]佳木斯大学,黑龙江佳木斯154007 [2]佳木斯大学附属第一医院检验科,黑龙江佳木斯154007

出　　处：《中国微生态学杂志》2018年第7期836-840,共5页Chinese Journal of Microecology

基　　金：黑龙江省自然科学基金项目(D201224);黑龙江省卫生计生委科研项目(2016-304);黑龙江省大学生创新创业项目(201710222001);佳木斯大学研究生科技创新项目(YM2016-056)

摘　　要：目的探讨改良Hodge试验(MHT)及改良碳青霉烯灭活试验(mCIM)检测肠杆菌科细菌金属碳青霉烯酶的应用价值。方法 VITEK 2Compact全自动细菌鉴定及药敏系统进行细菌鉴定和药敏试验,筛选2015-2017年非重复临床分离的碳青霉烯类耐药的肠杆菌科细菌,MHT及mCIM进行产碳青霉烯酶表型确证试验,PCR检测常见的金属碳青霉烯酶IMP-4、IMP-8、VIM-1、VIM-2、NDM基因。比较MHT及mCIM对肠杆菌科金属碳青霉烯酶的检测效能。结果本实验共收集40株临床分离菌株,MHT阳性36株,阳性率90.0%。mCIM阳性39株,阳性率为97.5%。PCR产物测序Blast比对证实4株为产IMP酶菌株,5株产NDM型菌株,未检测到VIM基因。MHT试验检测IMP酶的灵敏度、特异性、阳性预测值、阴性预测值分别为100.0%、11.1%、11.1%、100.0%,MHT检测NDM酶分别为40.0%、2.9%、5.6%、25.0%。mCIM检测IMP酶的灵敏度、特异性、阳性预测值、阴性预测值分别100.0%、2.8%、10.3%、100.0%,mCIM检测NDM型分别为100.0%、2.9%、12.8%、100.0%。结论 MHT及mCIM检测肠杆菌科细菌产金属碳青霉烯酶具有良好的灵敏度,但特异性偏低,应结合分子生物学方法进行检测,为感染控制提供保障。Objective To investigate the application value of modified Hodge test（MHT）and modified carbapenem inactivation method（mCIM）for detection of metallo-carbapenemase in Enterobacteriaceae.Methods VITEK 2 Compact automatic analysis system was used to identify and test the drug sensitivity of non-repeated strains of carbapenem-resistant Enterobacteriaceae（CRE）isolated during 2015-2017.MHT and mCIM were conducted to confirm the phenotypes of carbapenemases,and PCR was used to detect common IMP-4,IMP-8,VIM-1,VIM-2 and NDM genes.The performances of MHT and mCIM in the detection of metallo-carbapenemases were compared.Results A total of 40 clinical isolates were detected.Among which 36 isolates（90.0%） were positive by MHT,while 39 isolates（97.5%） were positive by mCIM.Sequencing of PCR products and Blast confirmed that 4 strains were IMP producing strains while 5 strains were NDM producing strains;no VIM positive strains were detected.The sensitivity,specificity,positive predictive value and negative predictive value of MHT for IMP were 100.0%,11.1%,11.1% and100.0% respectively,while those for NDM were 40.0%,2.9%,5.6% and 25.0% respectively.The sensitivity,specificity,positive predictive value and negative predictive value of mCIM for IMP were 100.0%,2.8%,10.3% and 100.0% respectively,while those for NDM were 100.0%,2.9%,12.8% and100.0% respectively.Conclusion MHT and mCIM have a good sensitivity for the detection of metallo-carbapenemases in Enterobacteriaceae,but the specificity is low.It is better to use them in combination with molecular biology methods to provide guaranteed results.

关 键 词：碳青霉烯酶 改良HODGE试验 改良碳青霉烯灭活试验 金属碳青霉烯酶 

分 类 号：R446.5[医药卫生—诊断学]