摘要
目的评估改良碳青霉烯灭活试验(mCIM)在检测临床产碳青霉烯酶革兰阴性杆菌中的应用价值。方法采用mCIM、改良Hodge(MHT)及Carba NP试验分别检测106株碳青霉烯酶基因阳性的革兰阴性杆菌(36株肠杆菌科细菌、26株铜绿假单胞菌及44株鲍曼不动杆菌),并比较差异。同时,收集湘雅医院2016年1月-12月临床分离的非重复性耐碳青霉烯类革兰阴性杆菌106株,同期随机选取100株分离的碳青霉烯类敏感菌株作为对照组,mCIM试验检测碳青霉烯酶,PCR检测碳青霉烯酶基因,分析其敏感性及特异性。结果(1)106株碳青霉烯酶基因阳性菌株,mCIM试验:肠杆菌科细菌的敏感性、特异性为88.9%(32/36),铜绿假单胞菌均为阴性。MHT试验:肠杆菌科细菌的敏感性、特异性为77.8%(28/36),铜绿假单胞菌的敏感性、特异性为69.2%(18/26)。Carba NP试验:肠杆菌科细菌的敏感性、特异性为97.2%(35/36),铜绿假单胞菌的敏感性、特异性为57.7%(15/26)。鲍曼不动杆菌3种方法均为阴性。肠杆菌科细菌中,MHT与Carba NP试验差异有统计学意义(χ^2=6.222,P=0.028),MHT与mCIM试验差异无统计学意义(χ^2=1.600,P=0.343),Carba NP与mCIM试验差异无统计学意义(χ^2=1.934,P=0.357);铜绿假单胞菌中,MHT与Carba NP试验阳性,二者差异无统计学意义(χ^2=0.746,P=0.565)。(2)144株临床分离肺炎克雷伯菌(碳青霉烯类耐药及敏感菌株分别为44株、100株),采用美罗培南和亚胺培南分别做mCIM试验,其敏感性和特异性均为100%,且与PCR的结果一致。结论mCIM试验在肠杆菌科细菌中敏感性高、特异性强,操作简单,结果易于判断,具有良好的临床应用价值。
Objective To evaluate the performance of the modified carbapenem inactivation method(mCIM)for detection of clinical carbapenemase-producing Gram-negative bacilli.Methods A total of 106 strains of Gram-negative bacillus isolates(36 Enterobacteriaceae,44 Acinetobacter baumannii,and 26 Pseudomonas aeruginosa)carrying carbapenemase gene were detected with mCIM,modified Hodge test(MHT)and Carba NP,respectively.At the same time,144 Enterobacteriaceae strains[44 carbapenems-resistant Enterobacteriaceae(CRE)and 100 carbapenems-sensitive Enterobacteriaceae(CSE)]isolated from clinical specimens in Xiangya Hospital from January 2016 to December 2016 were detected using both mCIM and PCR.Then their sensitivity and specificity were compared.Results(1)For the 106 carbapenemase-producing Gram-negative bacilli,the sensitivity and specificity of the three methods were detected(mCIM:Enterobacteriaceae 88.9%,P.aeruginosa 0.0%;MHT:Enterobacteriaceae 77.8%,P.aeruginosa 69.2%;Carba NP:Enterobacteriaceae 97.2%,P.aeruginosa 57.7%),and all the three methods showed negative results for A.baumannii.In Enterobacteriaceae,there was a significant difference between MHT and Carba NP(χ^2=6.222,P=0.028),but not between MHT and mCIM(χ^2=1.600,P=0.343)and between Carba NP and mCIM(χ^2=1.934,P=0.357).In P.aeruginosa,only the results of MHT and Carba NP were positive,and there was no significant difference between the two methods(χ^2=0.746,P=0.565).(2)Among the 144 Enterobacteriaceae strains(44 CRE and 100 CSE)isolated from clinical specimens,there were 44 positive strains and 100 negative strains by mCIM with meropenem and imipenem.The sensitivity and specificity were 100%,consistent with the results of PCR.Conclusion The mCIM has high sensitivity and specificity for Enterobacteriaceae.The operation is simple and the result is easy to interpret.It has good clinical application value.
作者
李军
邓凌峰
陶晓燕
于婷
王海晨
胡咏梅
豆清娅
邹明祥
LI Jun;DENG Lingfeng;TAO Xiaoyan;YU Ting;WANG Haichen;HU Yongmei;DOU Qingya;ZOU Mingxiang(Department of Clinical Laboratory,Xiangya Hospital,Central South University,Changsha,Hu′nan 410008,China;不详)
出处
《中国微生态学杂志》
CAS
CSCD
2020年第7期827-832,共6页
Chinese Journal of Microecology
基金
国家自然科学基金青年科学基金(81702068)
湖南省自然科学基金(2017JJ3478)
湖南省自然科学基金(2020JJ4886)。
