河北医科大学学报

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CIM与mCIM筛选肠杆菌科细菌产碳青霉烯酶能力比较

  

  1. 1.河北医科大学第二医院检验科，河北 石家庄 050000；2.河北医科大学研究生院，河北 石家庄 050017；
    3.河北省石家庄市第一医院内分泌科，河北 石家庄 050011
  • 出版日期:2018-08-25 发布日期:2018-07-25
  • 作者简介:马玉兰（1993-），女，河北石家庄人，河北医科大学第二医院医学硕士研究生，从事临床检验学研究。

Comparison of carbapenem inactivation method and modified carbapenem inactivation method for screening of carbapenemaseproducing Enterobacteriaceae#br#

  1. 1.Department of Clinical Laboratory, the Sencond Hospital of Hebei Medical University, Shijiazhuang
    050000, China; 2.The Graduate School of Hebei Medical University, Shijiazhuang 050017, China;
    3.Department of Endocrinology， the First Hospital of  Shijiazhuang，
    Hebei Province， Shijiazhuang 050011，China
  • Online:2018-08-25 Published:2018-07-25

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摘要： ［摘要］〓
〖HTH〗目的〖HTSS〗〖KG*2〗评估碳青霉烯类失活法（carbapenem inactivation method，CIM）和改良碳青霉烯类失活法（modified carbapenem inactivation method，mCIM）对肠杆菌科细菌碳青霉烯酶表型筛选的能力。
〖HTH〗方法〖HTSS〗〖KG*2〗选取110株碳青霉烯类耐药肠杆菌科细菌及25株碳青霉烯类敏感肠杆菌科细菌，分别进行CIM和mCIM表型筛选试验，采用PCR法检测KPC2、NDM1、IMP4、VIM1、OXA48耐药基因，结果进行统计学分析。
〖HTH〗结果〖HTSS〗〖KG*2〗110株碳青霉烯类耐药肠杆菌科细菌中，有99株耐药基因检测阳性，包括77株KPC2型、15株NDM1型、2株同时携带KPC2和NDM1型、4株IMP4型和1株VIM1型。未检出OXA48型基因。25株碳青霉烯类敏感菌株基因检测均为阴性。CIM试验敏感度为87.9%，特异度为94.4%；mCIM试验敏感度为95.0%，特异度为91.7%。为了比较抑菌环直径大小对实验结果的影响，将CIM试验阴性菌株分为2组，耐药基因阳性组抑菌圈直径明显低于基因阴性组，差异有统计学意义（P＜001）。
〖HTH〗结论〖HTSS〗〖KG*2〗通过对试验步骤及结果判读标准的优化，mCIM试验不仅保留了成本低、操作简单、敏感度高、特异度好等优点，其碳青霉烯酶筛选能力也得到明显提升，是一种经济高效的表型筛选方法。

关键词: 肠杆菌科, 碳青霉烯酶, 基因检测

Abstract: ［Abstract］ Objective〖HTSS〗〓To evaluate the screening capacity of carbapenem inactivation method (CIM) and modified carbapenem inactivation method (mCIM) for phenotypic carbapenemase activity in Enterobacteriaceae bacteria.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 110 isolates of carbapenemresistant Enterobacteriaceae and 25 isolates of carbapenemsensitive Enterobacteriaceae were selected, and carbapenemase activity were determined by the CIM and mCIM, respectively. Meanwhile，the carbapenemase genes such as KPC2, NDM1, IMP4,VIM1 and OXA48 were detected by PCR. The examination results were analyzed statistically.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓Of the 110 carbapenemresistant Enterobacteriaceae strains，99 strains were positive detected by PCR, including 77 strains for KPC2, 15 strains for NDM1, 2 strains for both KPC2 and NDM1, 4 strains for IMP4, and 1 strain for VIM1. The strain carring OXA48 gene was not detected. Twentyfive carbapenemsensitive strains were all negative. For CIM, the sensitivity is 87.9% and the specificity is 94.4%. For mCIM, the sensitivity is 95.0% and the specificity is 91.7%. In order to compare the effects of the diameter of bacteriostasis ring on the experimental results, the CIM negative strains were divided into two groups, carbapenemresistant gene positive group and carbapenemresistant gene negative group. The bacteriostasis diameter of the carbapenemresistant gene positive group was significantly lower than that of the gene negative group, and the difference was statistically significant（P＜001）.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓After the optimization of the experimental procedure and the interpretation criteria of the results, the mCIM not only retained the advantages of low cost, simple operation, high sensitivity and good specificity, but the screening ability of carbapenemases had also been significantly improved. mCIM should be a convenient, costsaving and efficient phenotypic screening method.

Key words: Enterobacteriaceae, carbapenemase； genetic testing

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