摘要
目的比较改良Hodge试验、Carba NP试验及碳青霉烯灭活试验(mCIM试验)对产碳青霉烯酶肺炎克雷伯菌快速表型筛选的能力。方法以PCR扩增肺炎克雷伯菌中携带的碳青霉烯酶相关耐药基因为金标准,比较改良Hodge试验、Carba NP试验及mCIM试验对202株碳青霉烯酶肺炎克雷伯菌试验菌的筛选能力。结果 202株试验菌经PCR扩增120株耐药基因阳性,产物测序得知75株只携带bla_(KPC-2)基因,20株同时携带bla_(KPC-2)和bla_(VIM-2)基因,19株同时携带bla_(KPC-2)和bla_(IMP-4)基因,3株只携带blaIMP-4基因,2株只携带bla_(VIM-2)基因,1株只携带bla_(NDM-1)基因;120株产碳青霉烯酶试验组菌株对亚胺培南、厄他培南及头孢菌素类抗菌药物的耐药率均为100.00%,对替加环素和多黏菌素B敏感。82株非产碳青霉烯酶的对照菌株对亚胺培南、厄他培南均敏感,对头孢曲松的耐药率为100.00%。以PCR结果为金标准,试验菌通过改良Hodge试验检测的灵敏度为92.50%,特异性为97.56%;Carba NP试验检测的灵敏度为94.17%,特异性为98.78%;mCIM试验检测的灵敏度为98.33%,特异性为100.00%。与PCR结果相比,改良Hodge试验的一致率为94.55%,Kappa值为0.8885;Carba NP试验的一致率为96.04%,Kappa值为0.9188;mCIM试验的一致率为99.01%,Kappa值为0.9796。结论 Carba NP试验和mCIM试验在快速检测产碳青霉烯酶的肺炎克雷伯菌较改良Hodge试验具有更高的敏感性和特异性,并且操作简便,适合在临床微生物学实验室、医院感染控制室及疾病预防控制系统各单位普及应用。
OBJECTIVE To compare the capability of modified Hodge test,modified carbapenem inactivation method(mCIM)and Carba NP test for rapid screening of phenotypes of carbapenemase-producing Klebsiella pneumoniae.METHODS PCR was used to amplify the carbapenemase-related genes in the K.pneumoniae and taken as the golden standard,and the capability of the modified Hodge test,Carba NP test and mCIM test in screening of 202 strains of carbapenemase-producing K.pneumoniae test isolates was observed and compared.RESULTS Of the 202 test strains,120 were PCR amplified positive for the drug resistance genes,the result of sequencing of amplified products showed that 75 strains only carried blaKPC gene,20 strains simultaneously carried blaKPC and blaVIM genes,19 strains simultaneously carried blaKPC and blaIMP genes,3 strains only carried blaIMP gene,2 strains only carried blaVIM gene,and 1 strain only carried blaNDM-1 gene.The drug resistance rates of the 120 strains of carbapenemase-producing K.pneumoniae isolates to imipenem,ertapenem and cephalosporins were 100%,while the strains were sensitive to tigecycline and polymyxin B.The 82 strains of non-carbapenemase-producing control isolates were sensitive to imipenem and ertapenem,while the drug resistance rate to ceftriaxone was 100%.Taken the PCR result as the golden standard,the sensitivities of the modified Hodge test,Carba NP test and mCIM test in screening of the test strains were 92.5%,94.17%and 98.33%,respectively;the specificities were 97.56%,98.78%and 100%,respectively.As compared with the PCR results,the consistency rate of the modified Hodge test was 94.55%,with the Kappa value 0.8885;the consistency rate of the Carba NP test was 96.04%,with Kappa value 0.9188;the consistency rate of the mCIM test was 99.01%,with Kappa value 0.9796.CONCLUSIONThe sensitivity and specificity of the Carba NP test and mCIM test are higher than those of the modified Hodge test in rapid detection of carbapenemase-producing K.pneumoniae,and the operation procedures are so simple that they are
作者
张青
陈喆
李克诚
夏菲
戴其锋
李云丰
钱定良
潘晓夫
李向阳
ZHANG Qing;CHEN Zhe;LI Ke-cheng;XIA Fei;DAI Qi-feng;LI Yun-feng;QIAN Ding-liang;PAN Xiao-fu;LI Xiang-yang(The Third Affiliated Hospital of Wenzhou Medical College,Ruian,Zhejiang325200,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2019年第10期1441-1446,共6页
Chinese Journal of Nosocomiology
基金
国家自然科学基金资助项目(81602246)
温州市公益性科技计划基金资助项目(Y20170812)
