双浓度联合改良碳青霉烯灭活试验筛查CRE的临床应用价值

doi:10.3969/j.issn.1673-8640.2020.10.004

摘要/Abstract

摘要：

目的评估双浓度联合改良碳青霉烯灭活试验（mCIM）筛查碳青霉烯类耐药肠杆菌科细菌（CRE）的临床应用价值。方法以VITEK 2 Compact N335卡的体外药物敏感性试验结果为标准,采用双浓度联合mCIM在231株分离自临床样本的肠杆菌科细菌中筛查CRE。结果 VITEK 2 Compact N335卡筛选出CRE阳性菌株52株,阴性菌株179株,阳性检出率为22.5%;mCIM筛出CRE阳性菌株52株,双浓度联合mCIM筛出CRE阳性菌株53株,阴性菌株178株,阳性检出率为22.9%。以VITEK 2 Compact检测结果为参考,符合率为98.7%,敏感性为98.1%,特异性为98.9%;将mCIM检测阳性的52株CRE继续进行乙二胺四乙酸改良碳青霉烯灭活试验（eCIM）,结果显示有13株肠杆菌科细菌金属-β-内酰胺酶为阳性,金属-β-内酰胺酶占碳青霉烯酶的25%。结论双浓度联合mCIM筛查CRE具有操作简单、不需要特殊仪器、结果易于观察等优点,适合在各级医院的微生物实验室中推广使用。对mCIM阳性菌株加做eCIM非常必要,有利于临床个性化用药。

关键词: 双浓度筛查法, 改良碳青霉烯灭活试验, 碳青霉烯类耐药肠杆菌科细菌, 乙二胺四乙酸改良碳青霉烯灭活试验

Abstract:

Objective To evaluate the role of double concentration combined modified carbapenem inactivation method（mCIM） for screening carbapenem-resistant Enterobacteriaceae（CRE）. Methods Based on the drug susceptibility test of VITEK 2 Compact N335 card,231 isolates of Enterobacteriaceae isolated from clinical samples were screened for CRE by double concentration combined mCIM. Results Totally,52 isolates of CRE were screened by VITEK 2 Compact N335 card,179 isolates were negative,and the positive rate was 22.5%. Totally,52 isolates of CRE were screened by mCIM. A total of 53 isolates of CRE were screened by double concentration combined mCIM,178 isolates were negative,and the positive rate was 22.9%. Based on the durg susceptibility test of VITEK 2 Compact N335 card,the consistency rate,sensitivity and specificity were 98.7%,98.1% and 98.9%,respectively. A total of 52 isolates with positive mCIM results were continued to do ethylenediamine tetraacetic acid-modified carbapenem inactivation method（eCIM）. The results showed that 13 isolates of Enterobacteriaceae were metallo-β-lactamase positive,and the positive rate of carbapenemases was 25%. Conclusions The double concentration combined mCIM for CRE screening has the advantages of simple operation,no need for special instruments and easy observation of results. It is suitable for using in all level microbiological laboratories. It is necessary for mCIM positive isolates to do eCIM again,which is conducive to individualized drug use in clinic.

Key words: Double concentration screening method, Modified carbapenem inactivation method, Carbapenem-resistant Enterobacteriaceae, ethylenediamine tetraacetic acid-modified carbapenem inactivation method

中图分类号:

R446.5

李世荣, 林怡菁, 蒋晓飞, 关明. 双浓度联合改良碳青霉烯灭活试验筛查CRE的临床应用价值[J]. 检验医学, 2020, 35(10): 979-982.

LI Shirong, LIN Lijing, JIANG Xiaofei, GUAN Ming. Role of double concentration combined modified carbapenem inactivation test for screening CRE[J]. Laboratory Medicine, 2020, 35(10): 979-982.

图/表 1

参考文献 14

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菌株编号	仪器法	双浓度筛查法	mCIM	双浓度联合mCIM
1~49	+	+	+	+
50（阴沟肠杆菌）	+	+	-	+
51（肺炎克雷伯菌）	+	2 μg/mL生长、4 μg/mL不生长	-	-
52（肺炎克雷伯菌）	+	2 μg/mL生长、4 μg/mL不生长	+	+
53（肺炎克雷伯菌）	-	2 μg/mL生长、4 μg/mL不生长	+	+
54（大肠埃希菌）	-	2 μg/mL生长、4 μg/mL不生长	+	+
55~59	-	2 μg/mL生长、4 μg/mL不生长	-	-
60~231	-	-	-	-

菌株编号	仪器法	双浓度筛查法	mCIM	双浓度联合mCIM
1~49	+	+	+	+
50（阴沟肠杆菌）	+	+	-	+
51（肺炎克雷伯菌）	+	2 μg/mL生长、4 μg/mL不生长	-	-
52（肺炎克雷伯菌）	+	2 μg/mL生长、4 μg/mL不生长	+	+
53（肺炎克雷伯菌）	-	2 μg/mL生长、4 μg/mL不生长	+	+
54（大肠埃希菌）	-	2 μg/mL生长、4 μg/mL不生长	+	+
55~59	-	2 μg/mL生长、4 μg/mL不生长	-	-
60~231	-	-	-	-