三种表型试验筛选产碳青霉烯酶肺炎克雷伯菌的临床效能评价  

Evaluation of clinical efficacy of three phenotypic tests for screening carbapenemaseproducing Klebsiella pneumoniae

作　　者：王群 叶梅毅 孙杨 陈涛[2] 王芳[3] 王方芳[4] 黄春华 林蕾[1] WANG Qun;YE Meiyi;SUN Yang;CHEN Tao;WANG Fang;WANG Fangfang;HUANG Chunhua;LIN Lei(Department of Clinical Laboratory,People's Hospital of Dayi County,Dayi,Sichuan 611330,P.R.China;Department of Clinical Laboratory,Xindu District People's Hospital,Chengdu,Sichuan 610500,P.R.China;Department of Clinical Laboratory,TCM Hospital of Sichuan Province,Chengdu,Sichuan 610032,P.R.China;Department of Clinical Laboratory,Pengzhou People's Hospital,Pengzhou,Sichuan 611930,P.R.China;Department of Clinical Laboratory,Sichuan Tianfu New Area People's Hospital,Chengdu,Sichuan 611330,P.R.China)

机构地区：[1]大邑县人民医院检验科,四川大邑611330 [2]成都市新都区人民医院检验科,成都610500 [3]四川省中医院检验科,成都610032 [4]彭州市人民医院检验科,四川彭州611930 [5]四川天府新区人民医院检验科,成都610000

出　　处：《华西医学》2023年第8期1148-1153,共6页West China Medical Journal

基　　金：成都市卫生健康委员会医学科研课题(2021060)。

摘　　要：目的比较改良Hodge试验(modified Hodge test,MHT)、改良碳青霉烯灭活试验(modified carbapenem inactivation method,m CIM)和EDTA-碳青霉烯灭活试验(EDTA-carbapenem inactivation method,e CIM)对产碳青霉烯酶肺炎克雷伯菌耐药表型的筛选能力。方法收集2019年1月—2021年12月成都地区5家医院临床分离的耐碳青霉烯肺炎克雷伯菌(carbapenem resistant Klebsiella pneumoniae,CRKP)菌株,并随机收集同时期分离的碳青霉烯敏感肺炎克雷伯菌(carbapenem sensitive Klebsiella pneumoniae,CSKP)。以聚合酶链反应(polymerase chain reaction,PCR)扩增碳青霉烯耐药基因作为金标准,比较3种表型试验结果与基因检测结果的一致性。结果共分离CRKP 160株,CSKP 120株。在160株CRKP中,156株检出碳青霉烯耐药基因,其中105株携带blaKPC-2,41株携带blaNDM-1,8株携带blaKPC-19,1株携带bla_(IMP-1),1株同时携带blaKPC-2和bla_(NDM-1)。120株CSKP均未检出耐药基因。MHT和m CIM筛查碳青霉烯酶的灵敏度和特异度分别为73.08%(114/156)、96.67%(116/120)和97.44%(152/156)、98.33%(118/120)。e CIM筛查金属酶的灵敏度和特异度分别为95.35%(41/43)和100%(120/120)。结论MHT检测碳青霉烯酶的敏感性较低,用于检测金属酶时易产生假阴性;m CIM敏感性高,与PCR基因检测结果一致;m CIM与e CIM联合检测能更有效筛查碳青霉烯酶,并且能区分碳青霉烯酶类型。Objective To compare the screening ability of modified Hodge test(MHT),modified carbapenem inactivation method(m CIM)and EDTA-carbapenem inactivation method(e CIM)for drug resistance phenotype of carbapenemase-producing Klebsiella pneumoniae.Methods Carbapenem resistant Klebsiella pneumoniae(CRKP)strains clinically isolated from 5 hospitals in Chengdu between January 2019 and December 2021 were collected,and the carbapenem sensitive Klebsiella pneumoniae(CSKP)strains isolated in the same period were randomly collected.Polymerase chain reaction(PCR)-amplified carbapenem resistance gene as the gold standard,the consistencies between the results of the three phenotypic tests and the results of genetic testing were compared.Results A total of 160 CRKP strains and 120 CSKP strains were isolated.Among the 160 CRKP strains,carbapenem resistance genes were detected in156 strains,including 105 strains of b_(laKPC-2),41 strains of b_(laNDM-1,8)strains of b_(laKPC-19,1)strain of blaIMP-1,and 1 strain carrying both b_(laKPC-2)and b_(laNDM-1).None of the 120 CSKP drug resistance genes were detected.The sensitivity and specificity of carbapenem screening for MHT and m CIM were 73.08%(114/156),96.67%(116/120),97.44%(152/156)and98.33%(118/120),respectively.The sensitivity and specificity of e CIM for screening metalloenzymes were 95.35%(41/43)and 100%(120/120),respectively.Conclusions The sensitivity of MHT to detect carbapenemase is lower than that of the other two methods,and it is easy to produce false negatives when it is used to detect metalloenzymes.The m CIM has high sensitivity and is consistent with the PCR genetic test results.The combined detection of m CIM and e CIM can screen carbapenemases more effectively and distinguish the types of carbapenemases.

关 键 词：碳青霉烯酶 肺炎克雷伯菌 改良HODGE试验 改良碳青霉烯灭活试验 EDTA-碳青霉烯灭活试验 

分 类 号：R446.5[医药卫生—诊断学]