摘要
目的 评估改良碳青霉烯灭活试验/乙二胺四乙酸(EDTA)改良碳青霉烯灭活试验(mCIM/eCIM)和碳青霉烯酶抑制剂增强试验检测产碳青霉烯酶肠杆菌目细菌基因型别的临床价值。方法 本研究纳入复旦大学中山医院2020年1-12月耐厄他培南或亚胺培南或美罗培南的190株肠杆菌目细菌,分别用mCIM/eCIM和碳青霉烯酶抑制剂增强试验检测CRE产生的碳青霉烯酶型别,同时使用聚合酶链式反应(PCR)检测结果作为金标准。结果和PCR比较,碳青霉烯酶抑制剂增强试验检测A类丝氨酸碳青霉烯酶的灵敏度98.16%,特异性为100.00%;检测金属β-内酰胺酶的灵敏度为100.00%,特异性为100.00%。mCIM/eCIM检测A类丝氨酸碳青霉烯酶的灵敏度为95.70%,特异性为100.00%;检测金属β-内酰胺酶的灵敏度93.10%,特异性为100.00%,但eCIM试验无法检测同时产A和B类酶的菌株。结论 碳青霉烯酶抑制剂增强试验和mCIM/eCIM方法检测A类丝氨酸碳青霉烯酶和金属β-内酰胺酶都具有较高的灵敏度和特异性。其中碳青霉烯酶抑制剂增强试验操作性更强,并能区分同时产A和B类碳青霉烯酶的菌株,但测试成本较mCIM/eCIM高。因此不同层级的微生物实验室可以根据自身条件包括成本、人员、场地和设备等客观因素,选择性地常规开展CRE的表型检测。
OBJECTIVE To evaluate the clinical values of modified carbapenem inactivation test/ethylenediaminetetraacetic acid(EDTA) modified carbapenem inactivation test(mCIM/eCIM) and carbapenemase inhibitor enhancement test in detection of carbapenemases produced by Enterobacteriaceae. METHODS A total of 190 strains of ertapenem-,imipenem-or meropenem-resistant Enterobacteriaceae that were isolated from Zhongshan Hospital Affiliated to Fudan University from Jan 2020 to Dec 2020 were enrolled in the study. The types of carbapenemases produced by CRE were detected by respectively using mCIM/eCIM and carbapenemase inhibitor enhancement test, and the result of polymerase chain reaction(PCR) test was taken as gold standard. RESULTS As compared with PCR, the sensitivity of the carbapenemase inhibitor enhancement test was 98.16% in detection of class A serine carbapenemases, the specificity 100.00%;the sensitivity was 100.00% in detection of metallo-beta-lactamase, the specificity 100.00%. The sensitivity of the mCIM/eCIM was 95.70% in detection of class A serine carbapenemases, the specificity 100.00%;the sensitivity was 93.10% in detection of metallo-beta-lactamase, the specificity 100.00%;however, the eCIM could not detect the strains that produced both class A and B enzymes. CONCLUSION Both carbapenemase inhibitor enhancement test and mCIM/eCIM show high sensitivity and specificity in detection of class A serine carbapenemases and metallo-beta-lactamase. The carbapenemase inhibition enhancement test is more operable and can distinguish the strains that produce both class A and B carbapenemases, but the test cost is higher as compared with mCIM/eCIM. Therefore, it is necessary for the microbiological laboratories at different levels to alternatively carry out the phenotypic test for CRE strains based on their own conditions, including objective factors such as cost, personnel, site and equipment.
作者
黄声雷
周春妹
曹锦楠
史庆丰
马艳
王蓓丽
郭玮
胡必杰
HUANG Sheng-lei;ZHOU Chun-mei;CAO Jin-nan;SHI Qing-feng;MA Yan;WANG Bei-li;GUO Wei;HU Bi-jie(Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第5期669-673,共5页
Chinese Journal of Nosocomiology
基金
上海市科委应急科技攻关基金资助项目(20411950500)
白求恩·中青年医生优才培养计划项目(BCF-SY-0311-20190807-07)
复旦大学附属中山医院临床研究专项基金资助项目(2018ZSLC06)。
