GeneXpert联合灌洗液培养在肾移植供者来源CRKP检测中的临床应用  

Detection of donor kidney carrier carbapenem-resistant Klebsiella pneumoniae using combined GeneXpert and culture of kidney perfusion fluid

作　　者：李大伟[1] 高芳[2] 陈若洋 吴佳晋 应亮[1] 钟晨 邱丰[1] 袁晓东 张明[1] Li Dawei;Gao Fang;Chen Ruoyang;Wu Jiajin;Ying Liang;Zhong Chen;Qiu Feng;Yuan Xiaodong;Zhang Ming(Department of Urology,Affiliated Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200120,China;Binzhou People's Hospital Health Management Center,Bingzhou 256600,China)

机构地区：[1]上海交通大学医学院附属仁济医院泌尿外科,200012 [2]山东省滨州市人民医院健康管理中心,256600

出　　处：《中华器官移植杂志》2020年第4期232-236,共5页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金(81800657、81670523、81770748);中国器官移植发展基金会器官移植专项扶持"菁英计划"(2019JYJH14)。

摘　　要：目的:探讨器官捐献供者来源耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的快速、准确的诊断方法。方法:回顾性分析2016年1月至2020年4月上海交通大学医学院附属仁济医院泌尿外科的1120例器官捐献供肾临床标本的鉴定及培养结果。1120例供肾行灌洗液培养(无菌管送检);451例供肾行灌洗液培养(无菌管+双血培养瓶送检);729例除灌洗液培养外,术前加做灌洗液GeneXpert快速细菌耐药酶检测。结果:经实验室检测和临床综合判定,供肾携带CRKP共21例(21/1120,1.88%)。GeneXpert检测729例标本中KPC阳性9例,实际携带CRKP为16例,敏感度56.3%,特异度100%,假阳性0,假阴性43.7%,ROC-AUC为0.781。GeneXpert单次耗时50~60 min。灌洗液培养(无菌管)检出CRKP阳性11例,敏感度52.3%,特异度100%,假阳性0,假阴性47.6%,ROC-AUC为0.762。灌洗液培养(厌氧瓶)检出CRKP 15例,敏感度和特异度均为100%,假阳性和假阴性均为0,ROC-AUC为1。灌洗液培养(需氧瓶)敏感度60%,特异度100%,假阳性0,假阴性40%,ROC-AUC为0.80。结论:Genexpert可以进行快速的CRKP筛查,耗时短,特异度高。可以作为CRKP快速筛查的重要手段。使用血培养技术(厌氧瓶)进行灌洗液CRKP检测具有极高的诊断价值。两种技术相结合既保证了CRKP检测的时效性,又能保证准确性,值得临床推广。Objective To explorer the optimal method of detecting donor kidney carrier carbapenem-resistant Klebsiella pneumoniae(CRKP).Methods Clinical data were retrospectively analyzed for 1120 donation-after-circulatory-death(DCD)kidneys and bacterial detection of kidney perfusion fluid was performed from January 2015 to January 2019.A total of 1120 kidney perfusion fluid samples were collected with sterile tubes and submitted for culturing.And 451 specimens were delivered in sterile tubes and blood culture bottles simultaneously And 729 specimens assayed for carbapenemase genes with GeneXpert.Results Among 1120 kidneys,CRKP was confirmed in 21 grafts with an infection rate of 1.87%.The detection of carbapenemase genes with Genexpert showed that KPC was positive for 9/16 CRKP positive grafts.Sensitivity,specificity,false-positive rate,false-negative rate and ROC-AUC were calculated at 56.3%,100%,0,43.7%and 0.781 respectively.And 11 specimens delivered with sterile tube were culture positive for CRKP.Sensitivity,specificity,false-positive rate,false-negative rate and ROC-AUC were calculated at 52.3%,100%,0,47.6%and 0.762 respectively.Among 451 perfusion fluid samples collected with anaerobic blood culture bottle,15 samples had a positive culture for CRKP.Sensitivity,specificity,false-positive rate,false-negative rate and ROC-AUC were calculated at 100%,100%,0,0 and 1 respectively.In terms to anaerobic blood culture bottle,sensitivity,specificity,false-positive rate,false-negative rate and ROC-AUC were calculated at 60%,100%,0,40%and 0.80 respectively.Conclusions Genexpert assay is suitable for rapid and convenient detection of carbapenemase genes using kidney perfusion fluid.Culturing perfusion fluid samples collected with anaerobic blood culture bottle is clinically valuable diagnostic tool of CRKP.A combination of both methods is worthy of clinical promotion and application diagnosis of donor kidney derived CRKP in terms of greater accuracy and timeliness.

关 键 词：肾移植 肺炎克雷伯菌 灌洗液 

分 类 号：R699.2[医药卫生—泌尿科学]