三种检测常见碳青霉烯酶型方法的评估研究  

Evaluation of three methods for detecting common carbapenemases

作　　者：邵丽娜 赵锋[3] 徐佳恩 朱水龙[2] 俞云松[1] Shao Lina;Zhao Feng;Xu Jia′en;Zhu Shuilong;Yu Yunsong(Department of Infectious Diseases,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;Department of Clinical Laboratory,No.3 People′s Hospital of Xiaoshan,Hangzhou 311251,China;Department of Clinical Laboratory,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院感染科,杭州310016 [2]杭州市萧山区第三人民医院检验科,杭州311251 [3]浙江大学医学院附属邵逸夫医院检验科,杭州310016

出　　处：《中华微生物学和免疫学杂志》2023年第10期763-768,共6页Chinese Journal of Microbiology and Immunology

摘　　要：目的评估mCIM联合eCIM试验、Carba-5和Carba-R三种方法检测碳青霉烯类耐药细菌(carbapenem-resistant organisms,CRO)中常见碳青霉烯酶型的性能。方法随机挑选2019年1月至2020年12月浙江大学医学院附属邵逸夫医院临床分离的122株非重复CRO菌株,应用生物梅里埃MALDI-TOF MS全自动快速质谱仪对菌株进行菌种鉴定,分别采用改良碳青霉烯类抗生素灭活试验(mCIM联合eCIM试验)、Carba-5检测条和Carba-R试剂盒对所有菌株进行碳青霉烯酶型检测;以PCR法检测结果为金标准,评价上述3种检测方法的性能。结果122株CRO菌株属于12个不同菌种,PCR法碳青霉烯酶型检测结果:共112株检测结果阳性,KPC-2型阳性70株,占57%(70/122),其中肺炎克雷伯菌46株,铜绿假单胞菌12株,其他菌株12株;OXA-232型阳性19株占15%(19/122),均为肺炎克雷伯菌;NDM型阳性20株占16%(20/122),其中NDM-1型阳性7株和NDM-5型阳性13株,以大肠埃希菌为主(12/20);IMP-4型阳性2株,分别为肺炎克雷伯菌和阿氏肠杆菌;检测出1株同时产KPC-2和IMP-4的肺炎克雷伯菌;未检测到VIM型碳青霉烯酶;有10株未检出以上5种基因型。与金标准PCR方法相比mCIM联合eCIM试验灵敏度为95.65%(22/23),特异度为100.00%(90/90),阳性预测值(PPV)为100.00%(22/22),阴性预测值(NPV)为98.90%(90/91),诊断准确度为99.11%(112/113);Carba-5和Carba-R试验的灵敏度、特异性、PPV、NPV和诊断准确度均为100%。结论碳青霉烯耐药肠杆菌目细菌和铜绿假单胞菌临床微生物实验室可以使用Carba-5试验快速、准确地检测常见碳青霉烯酶型,有条件的实验室还可以选择Carba-R试验,并监测患者是否存在碳青霉烯耐药菌的定植;而Carba-5和Carba-R检测结果阴性时,建议结合药敏结果进行mCIM联合eCIM试验检测。ObjectiveTo assess the performance of mCIM in combination with eCIM test as well as Carba-5 and Carba-R tests in detecting common carbapenemases in carbapenem-resistant organisms(CRO).MethodsIn this study,122 non-duplicate clinical CRO strains isolated in Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,from January 2019 to December 2020 were randomly selected.These strains were identified using matrix-assisted laser desorption ionization time-of-flight mass spectrometry(MALDI-TOF MS).A modified carbapenem inactivation test(mCIM combined with eCIM test),Carba-5 and Carba-R were used to detect the types of carbapenemases in these strains.PCR results were used as the gold standard to evaluate the performance of the three methods.ResultsThe 122 CRO strains belonged to 12 different species.PCR results showed that carbapenemases were produced in 112 strains.KPC-2-producing strains accounted for 57%(70/122),which included 46 Klebsiella pneumoniae strains,12 Pseudomonas aeruginosa strains and 12 other strains.OXA-232-positive strains accounted for 15%(19/122),with Klebsiella pneumoniae being the only carrier(100%,19/19).NDM carbapenemases were identified in 16%of the strains(20/122),with NDM-1 and NDM-5 accounting for 35%(7/20)and 65%(13/20),respectively,and Escherichia coli was the predominant carrier(60%,12/20).IMP-4 was detected in one Klebsiella pneumoniae strain and one Enterobacter asteri strain.One Klebsiella pneumoniae strain produced KPC-2 and IMP-4,while none of the strains were found to produce VIM carbapenemases.In the remaining 10 strains,none of the above-mentioned carbapenemases were detected.Compared with the golden standard,the mCIM combined with eCIM test had a sensitivity of 95.65%(22/23),a specificity of 100%(90/90),a positive predictive value(PPV)of 100%(22/22),a negative predictive value(NPV)of 98.90%(90/91),and a diagnostic accuracy of 99.11%(112/113).The sensitivity,specificity,PPV,NPV and diagnostic accuracy of Carba-5 and Carba-R tests were all 100%.ConclusionsIn general clinica

关 键 词：碳青霉烯类耐药阴性菌 碳青霉烯酶 mCIM联合eCIM试验 Carba-5 Carba-R 

分 类 号：R446.5[医药卫生—诊断学]