两组方法检测耐碳青霉烯类肠杆菌碳青霉烯酶的临床价值  

The clinical value in detecting carbapenemase among Carbapenem-Resistant Enterobacteriaceae by two sets of methods

作　　者：车辉娟[1] 廖全凤 吴思颖[1] 刘雅[1] 张为利 彭丽 周益 康梅[1] CHE Hui-juan;LIAO Quan-feng;WU Si-ying;LIU Ya;ZHANG Wei-li;PENG Li;ZHOU Yi;KANG Mei(Department of Laboratory Medicine,West China Hospial,Sichuan University,Chengdu,Sichuan 610041,China)

机构地区：[1]四川大学华西医院实验医学科,四川成都610041 [2]成都上锦南府医院实验医学科

出　　处：《现代预防医学》2021年第3期524-527,共4页Modern Preventive Medicine

摘　　要：目的研究EDTA协同碳青霉烯类灭活法(EDTA synergistic carbapenem inactivation method,eCIM)联合改良碳青霉烯类灭活法(modified carbapenem inactivation method,mCIM)、简易EDTA协同碳青霉烯类灭活法(simple EDTA synergistic carbapenem inactivation method,esCIM)联合简易碳青霉烯类灭活法(simplified carbapenem inactivation method,sCIM)检测耐碳青霉烯类肠杆菌(Carbapenem-Resistant Enterobacteriaceae, CRE)丝氨酸碳青霉烯酶和金属β-内酰胺酶的临床价值。方法收集临床分离的CRE菌株57株,以PCR结果为金标准,同时进行eCIM联合mCIM、esCIM联合sCIM检测丝氨酸碳青霉烯酶和金属β-内酰胺酶。结果经PCR扩增后基因测序显示39株肺炎克雷伯菌中33株携带KPC-2基因,2株携带NDM-1基因,1株携带NDM-5基因,3株未检测出携带碳青霉烯酶基因;9株大肠埃希菌均携带NDM-5基因,9株阴沟肠杆菌均携带NDM-1基因。eCIM联合mCIM检测金属β-内酰胺酶的灵敏度95.2%(20/21)、特异度100%(33/33),检测丝氨酸碳青霉烯酶灵敏度100%(33/33)、特异度95.8%(23/24)。esCIM联合sCIM检测金属β-内酰胺酶灵敏度90.5%(19/21)、特异度100%(33/33),检测丝氨酸碳青霉烯酶灵敏度100%(33/33)、特异度91.7%(22/24)。结论两组方法检测丝氨酸碳青霉烯酶和金属酶敏感度、特异度均高;esCIM联合sCIM操作更加简易、检测耗时更短,更适用于基层医院临床微生物实验室操作。Objective To study the clinical value of EDTA synergistic carbapenem inactivation method(eCIM) combined with modified carbapenem inactivation method(mCIM) and simple EDTA synergistic carbapenem inactivation method(esCIM) combined with simplified carbapenem inactivation method(sCIM) in the detection of serine carbapenemase and metal β-lactamase among Carbapenem-Resistant Enterobacteriaceae(CRE). Methods A total of 57 clinically isolated CRE strains were collected, using PCR results as the gold standard, eCIM combined with mCIM and esCIM combined with sCIM were used to detect serine carbapenemase and metal β-lactamase. Results After PCR amplification, gene sequencing showed that among 39 strains of carbapenem-resistant Klebsiella pneumoniae, 33 strains carried the KPC-2 gene, 2 strains carried the NDM-1 gene, 1 strain carried the NDM-5 gene, and 3 strains were not detected to carry the carbapenemase encoding gene. Nine strains of carbapenem-resistant Escherichia coli all carried the NDM-5 gene, and 9 strains of carbapenem-resistant Enterobacter cloacae all carried the NDM-1 gene. The sensitivity of eCIM combined with mCIM to detect metal β-lactamase was 95.2%(20/21), the specificity was 100%(33/33), and the sensitivity of serine carbapenemase was 100%(33/33) and the specificity was 95.8 %(23/24). The sensitivity of esCIM combined with sCIM to detect metal β-lactamase was 90.5%(19/21) and the specificity was 100%(33/33), and the sensitivity for detection of serine carbapenemase was 100%(33/33) and the specificity was 91.7%(22/24). Conclusion Both sets of methods have high sensitivity and specificity for detecting serine carbapenemase and metalloenzyme;esCIM combined with sCIM is easier to operate, and the detection time is shorter, and it is more suitable for the operation of clinical microbiology laboratory in primary hospitals.

关 键 词：耐碳青霉烯类肠杆菌 丝氨酸碳青霉烯酶 金属Β-内酰胺酶 eCIM联合mCIM esCIM联合sCIM 

分 类 号：R115[医药卫生—公共卫生与预防医学]