Vitek MS快速检测产碳青霉烯酶肠杆菌目细菌的效果评估  

Evaluation of Vitek MS for rapid detection of carbapenemase-producing Enterobacterales

作　　者：刘璐 温海楠[1] 李婧 王惠 谢守军[1] 梁悦怡 刘焱超 孙启玉[1] LIU Lu;WEN Hainan;LI Jing;WANG Hui;XIE Shoujun;LIANG Yueyi;LIU Yanchao;SUN Qiyu(Department of Laboratory Medicine, Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei, China)

机构地区：[1]承德医学院附属医院检验科,河北承德067000

出　　处：《临床检验杂志》2022年第2期110-115,119,共7页Chinese Journal of Clinical Laboratory Science

摘　　要：目的探讨基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)快速检测产碳青霉烯酶肠杆菌目细菌(CP-CRE)的效果。方法选取2018年12月至2020年10月承德医学院附属医院分离的52株碳青霉烯类耐药肠杆菌目细菌(CRE)和30株碳青霉烯类敏感肠杆菌目细菌(CSE)。采用酶水解法建立Vitek MS检测CP-CRE的判断标准。定义logRQ=log(亚胺培南水解产物峰强度/亚胺培南峰强度),结合PCR结果绘制受试者工作特征曲线。当logRQ值≥cut-off值时,该菌产碳青霉烯酶,为CP-CRE,反之,该菌不产碳青霉烯酶。用同期46株肠杆菌目细菌进行前瞻性研究,以验证基于酶水解法的Vitek MS的检测效果。结果医院分离的52株CRE的logRQ值0.996±0.184,均为CP-CRE菌株;30株CSE的logRQ值-1.419±0.187,均不产碳青霉烯酶。酶水解法最适温育时间为30 min,cut-off值为-0.678,敏感性为100%,特异性为100%。前瞻性研究中,Vitek MS检测出40株CP-CRE和6株不产碳青霉烯酶肠杆菌目细菌,该结果与PCR检测结果一致性极强(Kappa=1.0)。结论基于酶水解法的Vitek MS能在短时间内检测出全部CP-CRE,敏感性高、特异性好、价格便宜,可用于临床CP-CRE的快速鉴定。Objective To investigate the effect of a matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF MS)assay in the detection of carbapenemase-producing carbapenem-resistant Enterobacterales(CP-CRE).Methods Fifty-two strains of CRE isolates and 30 strains of carbapenem-sensitive Enterobacterales(CSE)isolates were collected from clinical specimens in the Affiliated Hospital of Chengde Medical University during December 2018 and October 2020.Then,the judgment standard of CP-CRE detected by the Vitek MS and enzymatic hydrolysis assay was established.logRQ was defined as log(peak intensity of imipenem hydrolysate)/(peak intensity of imipenem),and the recevier operator characteristic(ROC)curve in combination with PCR results was drawn.When the logRQ value≥cut-off value,a strain produced carbapenemase,and was judged as CP-CRE.On the contrary,a strain was judged as CSE.Forty-six strains of Enterobacterales in the same period were used to verify the detection effect of Vitek MS based on the enzymatic hydrolysis assay.Results The logRQ values of 52 strains of CRE were 0.996±0.184,all of which were CP-CRE strains.However,the logRQ values of 30 strains of CSE were-1.419±0.187,and none of them produced carbapenemase.The optimal incubation time of the enzymatic hydrolysis assay was 30 minutes,and the cut-off value was-0.678.Both of its sensitivity and specificity were 100%.In 46 strains of Enterobacterales,40 were judged as CP-CRE strains and 6 as no production of carbapenemase by the Vitek MS,which were highly consistent with the results of PCR(Kappa=1.0).Conclusion All of CP-CRE strains can be detected in a short time by the Vitek MS based on an enzymatic hydrolysis assay,which has high sensitivity,high specificity and low price,and can be used for the rapid identification of clinical CP-CRE strains.

关 键 词：基质辅助激光解吸电离飞行时间质谱 碳青霉烯酶 肠杆菌目细菌 亚胺培南 酶水解法 

分 类 号：R446.5[医药卫生—诊断学]