mCIM和碳青霉烯酶抑制剂增强试验检测CRE和CRPA产酶表型的方法学评价  

Methodological Evaluation of mCIM and Carbapenemase Inhibitor-enhancing Assays to Detect CRE and CRPA Enzyme Producing Phenotypes

作　　者：尚佳文 徐文娜 许南松 刘晓敏[2] 曾秋耀[2] 郑炘[2] SHANG Jia-wen;XU Wen-na;XU Nan-song;LIU Xiao-min;ZENG Qiu-yao;ZHENG Xin(College of Medical Technology,Guangdong Medical University,Guangdong Dongguan 523808,China;Department of Clinical Laboratory,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center of Cancer Medicine,Guangzhou 510060,China)

机构地区：[1]广东医科大学医学技术学院,广东东莞523808 [2]中山大学肿瘤防治中心检验科,华南肿瘤学国家重点实验室肿瘤医学协同创新中心,广州510060

出　　处：《现代检验医学杂志》2023年第3期165-169,共5页Journal of Modern Laboratory Medicine

摘　　要：目的综合评估改良碳青霉烯酶灭活试验(mCIM)和碳青霉烯酶抑制剂增强试验对碳青霉烯酶检测和分型能力。方法采用mCIM和碳青霉烯酶抑制剂增强试验检测中山大学肿瘤防治中心2019~2022年临床分离并保存的47株耐碳青霉烯类肠杆菌目细菌(carbapenem-resistant Enterobacterales,CRE)和42株耐碳青霉烯类铜绿假单胞菌(carbapenem-resistant Pseudomonas aeruginosa,CRPA)的产酶表型,胶体金法对检测结果进行验证比对,通过卡方检验进行统计分析,并从多角度综合评价。结果mCIM检测CRE和CRPA的阳性率分别为70.2%和35.7%,碳青霉烯酶不确定占比为25.5%和11.9%。增强试验检测47株CRE:44.7%产B类金属β内酰胺酶,17.0%产A类碳青霉烯酶,不产A或B类碳青霉烯酶的菌株占38.3%;增强试验检测42株CRPA:2.4%产B类金属β内酰胺酶,90.4%产A类碳青霉烯酶,同时产A类碳青霉烯酶和B类金属β-内酰胺酶的菌株占4.8%,不产A或B类碳青霉烯酶的菌株占2.4%。两种方法检测CRE差异有统计学意义(χ^(2)=17.803,P=0.01),检测CRPA差异无统计学意义(χ^(2)=4.632,P=0.592)。胶体金法验证:产碳青霉烯酶的阳性符合率为84.6%,产丝氨酸酶的阳性符合率为80%,产金属酶的阳性符合率为100%。结论检测CRE两种方法均适用且差异不大,CRPA更推荐碳青霉烯酶抑制剂增强试验,胶体金值得推广,临床实验室应根据实际条件选择检测方法。Objective To comprehensively evaluate the ability of modified carbapenemase inactivation test(mCIM)and carbapenemase inhibitor enhancement test for carbapenemase detection and typing.Methods mCIM and carbapenemase inhibitor enhancement test were used to detect 47 strains of carbapenem-resistant Enterobacterales(CRE)and 42 strains of carbapenem-resistant Pseudomonas aeruginosa(CRPA),which isolated and stored in Sun Yat-sen University Cancer Center from 2019 to 2022,the detection results were verified by colloidal gold method,statistical analysis was performed by chi-square test,and comprehensive evaluation was performed from multiple angles.Results The positive rates of CRE and CRPA detected by mCIM were 70.2%and 35.7%,and the proportion of carbapenemase uncertainty was 25.5%and 11.9%.The results of enhanced test showed that 44.7%of the CRE strains produced class B metallo-β-lactamases,17.0%produced class A carbapenemases,and 38.3%did not produce class A or B carbapenemases.The results of enhanced test showed that 2.4%of the CRPA strains produced class B metallo-β-lactamases,90.4%produced class A carbapenemases,4.8%produced both class A carbapenemases and class B metallo-β-lactamases,and 2.4%did not produce class A or B carbapenemases.There was significant difference in CRE detection between the two methods(χ^(2)=17.803,P=0.01),but no significant difference in CRPA detection between the two methods(χ^(2)=4.632,P=0.592).The results were verified by colloidal gold method:the positive coincidence rate of carbapenemase production was 84.6%,the positive coincidence rate of serine enzyme production was 80%,and the positive coincidence rate of metalloenzyme production was 100%.Conclusion The two methods of CRE detection were applicable and there was no significant difference.Carbapenemase inhibitor enhanced test is more recommended for CRPA detection,colloidal gold is worth promoting,clinical laboratories should choose the detection methods according to the actual conditions.

关 键 词：肠杆菌目 铜绿假单胞菌 改良碳青霉烯酶灭活试验 碳青霉烯酶抑制剂增强试验 胶体金法 

分 类 号：R446.5[医药卫生—诊断学]