碳青霉烯酶抑制剂检测产碳青霉烯酶肠杆菌科细菌的效能  

Efficiency of carbapenemase buffer solution in detection of carbapenemase-producing Enterobacteriaceae

作　　者：蔡依玫 张社彬 张轩 代奥 刘健平 龙一飞 刘玥[3] CAI Yi-mei;ZHANG She-bin;ZHANG Xuan;DAI Ao;LIU Jian-ping;LONG Yi-fei;LIU Yue(The Second Affiliated Hospital of Guangzhou University of Chinese Medicine/Guangdong Provincial Hospital of Chinese Medicine,Guangzhou,Guangdong510006,China;不详)

机构地区：[1]广州中医药大学第二附属医院/广东省中医院检验医学部,广东广州510006 [2]广州中医药大学基础医学院,广东广州510006 [3]广州中医药大学第一附属医院检验医学部,广东广州510405

出　　处：《中华医院感染学杂志》2023年第14期2081-2085,共5页Chinese Journal of Nosocomiology

基　　金：广东省中医药局中医药科研基金资助项目(20231145)。

摘　　要：目的评估迪尔碳青霉烯酶抑制剂检测碳青霉烯类耐药肠杆菌目细菌(CRE)产不同基因型碳青霉烯酶的效能。方法收集2018-2020年广东省中医院临床分离的73株非重复CRE。采用改良碳青霉烯灭活试验(mCIM)联合乙二胺四乙酸(EDTA)碳青霉烯灭活试验(eCIM)以及碳青霉烯酶抑制剂检测碳青霉烯酶,采用聚合酶链式反应(PCR)检测10种常见β-内酰胺酶基因。以PCR为金标法,评估两种表型试验的临床效能。结果mCIM试验阳性54株,产丝氨酸碳青霉烯酶20株,产金属β-内酰胺酶34株,符合率为98.63%(72/73)。碳青霉烯酶抑制剂检出56株产碳青霉烯酶,产A类酶22株,产B类酶34株。1株产OXA-181的摩根摩根菌为假阴性,2株不产碳青霉烯酶、高产头孢菌素酶DHA的CRE为假阳性。碳青霉烯酶抑制剂灵敏度和特异度分别为98.18%(54/55)和88.89%(16/18),符合率为95.89%(70/73)。结论mCIM联合eCIM无法区分A类和D类丝氨酸碳青霉烯酶。碳青霉烯酶抑制剂符合率较mCIM联合eCIM试验稍低,能有效鉴别A类和B类酶,但在D类酶和高产AmpC酶的CRE检测上仍存在不足。碳青霉烯酶抑制剂与mCIM/eCIM联合能更全面地实现碳青霉烯酶分型,精准指导临床合理用药。OBJECTIVE To evaluate the efficiency of carbapenemase buffer inhibitors in detection of carbapenemase in carbapenem-resistant Enterobacteriaceae(CRE).METHODS Totally 73strains of non-repetitive CRE were isolated from Guangdong Provincial Hospital of Chinese Medicine from 2018 to 2020.Carbapenemases were detected by means of modified carbapenem inactivation method(mCIM)combined with ethylenediamine tetraacetic acid(EDTA)and carbapenemase buffer inhibitors.The 10types of commonβ-lactamase genes were detected by polymerase chain reaction(PCR).PCR was selected as the gold standard to evaluate the clinical efficiencies of the two phenotypic trials.RESULTS Totally 54isolates were tested positive for mCIM.There were 20strains tested positive for serine carbapenemase and 34strains tested positive for metalβ-lactamase,with a coincidence rate of 98.63%(72/73).Totally 56strains of carbapenemase-producing CRE,22strains of class A enzyme-producing CRE and 34strains of class B enzyme-producing CRE were detected by carbapenemase buffer inhibitors.1strain of OXA-181-producing Morganella morganii was tested false negative,and 2strains of non-carbapenemase and high yield DHA serine cephalosporinase CRE were tested false positive.The sensitivity of the carbapenemase buffer inhibitors was 98.18%(54/55),with the specificity 88.89%(16/18),the coincidence rate 95.89%(70/73).CONCLUSION mCIM combined with eCIM can not distinguish between class A and class D serine carbapenemase.The coincidence rate of the carbapenemase buffer inhibitors is lower than that of the mCIM combined with eCIM,it can effectively distinguish between the class A and class B enzyme but can not detect the class D enzyme and high yield AmpC CRE strains.The carbapenemase buffer inhibitors combined with mCIM/eCIM may facilitate the roundly typing of carbapenemase and provide guidance for reasonable clinical use of antibiotics.

关 键 词：碳青霉烯类耐药肠杆菌目细菌 mCIM联合eCIM试验 碳青霉烯酶抑制剂 碳青霉烯酶抑制剂增强试验 丝氨酸碳青霉烯酶 金属Β-内酰胺酶 

分 类 号：R446.5[医药卫生—诊断学]