不同检验方案对碳青霉烯类非敏感类肠杆菌科细菌检测的临床应用

Clinical Application of Different Detection Methods for Carbapenem-Resistant Enterobacteriaceae

目的分析改良Hodge试验(MHT)、Carba NP direct试验(CNPt-d)、Carba NP试验(CNPt)对碳青霉烯类非敏感类肠杆菌科细菌(CRE)检测的临床应用价值。方法收集我院2018年5月-2019年5月临床分离的碳青霉烯类非敏感类肠杆菌科细菌138株,采用聚合酶链式反应(PCR)、MHT、CNPt-d、CNPt对碳青霉烯酶耐药基因进行检测,以PCR检测为金标准,分析MHT、CNPt-d、CNPt对碳青霉烯类非敏感类肠杆菌科细菌的检测价值。结果PCR检测结果显示138株碳青霉烯类非敏感类肠杆菌科细菌共检测出含碳青霉烯酶基因的CRE120株,其中NDM-1型大肠埃希菌10株,KPC-2型肠科杆菌106株,VIM-2型肺炎克雷伯菌4株;120株碳青霉烯酶基因阳性的CRE中,有110株MHT检测结果为阳性,阳性率为91.67%;120株碳青霉烯酶基因阳性的CRE中,有115株CNPt检测结果为阳性,阳性率为95.83%;120株碳青霉烯酶基因阳性的CRE中,有120株CNPt-d检测结果为阳性,阳性率为100.00%;MHT、CNPt-d、CNPt中,CNPt-d对碳青霉烯类非敏感类肠杆菌科细菌的检测价值最高。结论MHT、CNPt-d、CNPt均能迅速检测出碳青霉烯类非敏感类肠杆菌科细菌,但CNPt-d灵敏性更强,准确性更高,且无需昂贵的蛋白抽提液,试剂成本价廉,可作为碳青霉烯类非敏感类肠杆菌科细菌的有效筛查方法。

Objective To investigate clinical application of modified Hodge test(MHT),Carba NP direct test(CNPt-d),and Carba NP test(CNPt)for detecting carbapenem-resistant Enterobacteriaceae(CRE).Methods A total of 138 strainsCRE in our hospital from May 2018 to May 2019 were collected.The carbapenemase resistance genes were detected by polymerase chain reaction(PCR),MHT,CNPt-d and CNPt,respectively.The detection value of MHT,CNPt-d and CNPt for CRE was analyzed based on the gold standard of PCR detection.Results PCR results showed that 120 carbapenase positive-genes strains were detected in 138 CRE strains,including 10 NDM-1-positive Escherichia coli,106 strains KPC-2-positive Enterobacteriaceae and 4 VIM-2-positive Klebsiella pneumoniae.Among the 120 CRE strains with positive carbapenase gene,91.67%(110/120)of them was detected by MHT,95.83%(115/120)of them was detected by CNPt,and 100.00%(120/120)of them was detected by CNPt-d.Among the three methods,CNPt-d had the highest detection value for CRE bacteria.Conclusion MHT,CNPt-d and CNPt can rapidly detect CRE bacteria,but CNPt-d is more sensitive and accurate,and the test doesn’t need expensive protein extractas well as the reagent is cheap.It might be used as an effective screening method for CRE bacteria.