基质辅助激光解吸电离飞行时间质谱仪检测耐碳青霉烯肺炎克雷伯菌的价值  

The value of matrixassisted laser desorption ionization time of flight mass spectrometry in detecting carbapenem resistant Klebsiella pneumoniae

作　　者：吕辉[1] 范明琴 陈美红 陈宇航 卢丹凤 蔡鹏威[1] Lyu Hui;Fan Mingqin;Chen Meihong;Chen Yuhang;Lu Danfeng;Cai Pengwei(Department of Clinical Laboratory,Fujian Provincial Hospital South Branch,Fuzhou 350028,China)

机构地区：[1]福建省立医院南院检验科,福州350028

出　　处：《实用医技杂志》2024年第6期409-413,F0003,共6页Journal of Practical Medical Techniques

摘　　要：目的评估基质辅助激光解吸电离飞行时间质谱仪(MALDITOF MS)检测耐碳青霉烯肺炎克雷伯菌(CRKP)的价值。方法收集2020年1月至2023年1月我院住院患者分离的肺炎克雷伯菌108株,以亚胺培南或美罗培南卡片筛选出CRKP和碳青霉烯酶敏感肺炎克雷伯菌(CSKP),采用CLSIm100S27标准判断CRKP的药敏,采用聚合酶链反应(PCR)检测CRKP的耐药基因序列,采用MALDITOF MS检测CRKP和CSKP特征峰。以同期收集的100株肺炎克雷伯菌,对CRKP和CSKP的特征峰进行验证。结果108株肺炎克雷伯菌中25株CRKP和83株CSKP。25株CRKP均对碳青霉烯类、头孢菌素类氨曲南、喹诺酮类抗生素和氨基糖苷类抗生素存在不同程度的耐药性。83株CSKP几乎对所有类型的抗生素敏感。25株CRKP检出携带碳青霉烯酶基因25株,测序结果显示,携带blaKPC基因20株(80.0%),携带blaNDM基因3株(12.0%),携带bla OXA48基因2株(8.00%),未检出blaGES、blaIMP、blaNDM、blaVIM。CRKP的特征峰分别为4159.5 m/z、8369.7 m/z、10808.0 m/z,CSKP的特征峰分别为3599.6 m/z、10087.5 m/z。将同期收集的100株肺炎克雷伯菌进行验证,30株CRKP中,MALDITOF MS检测出28株CRKP,70株CSKP中,MALDITOF MS检测68株CSKP,MALDITOF MS检出准确度为96.0%(96/100)。结论本地区CRKP的耐药基因多为blaKPC,MALDITOF MS可快速检测CRKP,CRKP的特征峰分别为4159.5 m/z、8369.7 m/z、10808.0 m/z。Objective To evaluate the value of matrix assisted laser desorption ionization time of flight mass spectrometry(MALDITOF MS)in detecting carbapenem resistant Klebsiella pneumoniae(CRKP).Methods One hundred and eight strains of Klebsiella pneumoniae isolated from inpatients in our hospital from January 2020 to January 23 were collected.CRKP and carbapenem sensitive Klebsiella pneumoniae(CSKP)were screened out with imipenem or meropenem cards.The drug sensitivity of CRKP was judged by CLSI m100S27,and the drug resistance gene sequence of CRKP was detected with polymerase chain reaction(PCR),the MALDITOF MS was used to detect characteristic peaks of CRKP and carbapenem sensitive Klebsiella pneumoniae(CSKP).The characteristic peaks of CRKP and CSKP was verified by 100 strains of Klebsiella pneumoniae collected at the same time.Results Among the 108 strains of Klebsiella pneumoniae,25 strains were CRKP and 83 strains were CSKP.All 25 strains of CRKP were resistant to carbapenems,cephalosporins,aztreonam,quinolones and aminoglycosides to varying degrees.Eightythree strains of CSKP were sensitive to almost all types of antibiotics.Twentyfive CRKP strains were detected to carry carbapenemase genes.The sequencing results showed that 20 strains(80.0%)carried the blaKPC gene,3 strains(12.0%)carried the blaNDM gene and 2 strains(8.0%)carried the blaOXA48 gene.No blaGES,blaIMP,blaNDM or blaVIM were detected.The characteristic peaks of CRKP were 4159.5 m/z,8369.7 m/z and 10808.0 m/z,respectively,while the characteristic peaks of CSKP were 3599.6 m/z and 10087.5 m/z,respectively.One hundred Klebsiella pneumoniae strains were collected and detected by characteristic peaks of CRKP and CSKP from MALDITOF MS.Among 100 Klebsiella pneumoniae strains,30 CRKPs were detected 28 CRKPs and 70 CSKPs were detected 68 CSKPs by MALDITOF MS,with an accuracy of 96.0%(96/100).Conclusion The resistance genes of CRKP in this region are mostly blaKPC,and MALDITOF MS can quickly detect CRKP.The characteristic peaks of CRKP are 4159.5 m/z,8369.7 m/z

关 键 词：光谱法 质量 基质辅助激光解吸电离 聚合酶链反应 耐碳青霉烯类 肺炎克雷伯菌 

分 类 号：R446.5[医药卫生—诊断学]