Laboratory Detection of Enterobacteriaceae That Produce Carbapenemases
Laboratory Detection of Enterobacteriaceae That Produce Carbapenemases
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DOI：
10.1128/jcm.02117-12
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发表时间：
2012-12-01
影响因子：
9.4
通讯作者：
Pitout, Johann D. D.
中科院分区：
文献类型：
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作者：
Doyle, Diana;Peirano, Gisele;Pitout, Johann D. D.
本研究旨在评价改良Hodge试验（MHT）、Mastdiscs ID抑制剂组合纸片（MDI）、Rosco Diagnostica Neo-Sensitabs（RDS）、金属-β-内酰胺酶（MBL）Etest和内部多重PCR用于检测充分表征的产碳青霉烯酶肠杆菌科细菌。142株产碳青霉烯酶肠杆菌科（包括克雷伯菌属，大肠杆菌、弗氏柠檬酸杆菌和肠杆菌属）包括2008年至2009年期间从SMART全球监测项目中获得的数据。其中包括49株产KPC、27株产NDM、19株产Vim、14株产OXA-48样酶和5株产IMP的分离株以及28株碳青霉烯类耐药、碳青霉烯酶阴性分离株。MDI、RDS和MBL Etest遵循制造商的说明，MHT遵循CLSI指南。设计多重PCR检测KPC、NDM、Vim、IMP和OXA-48样碳青霉烯酶。总体而言，MDI的敏感性和特异性分别为78%和93%，RDS为80%和93%，MHT为58%和93%，MBL Etest为55%和100%。PCR的敏感性和特异性均为100%。MDI和RDS在检测KPC和NDM方面表现良好，但在检测VIM、IMP和OXA-48样酶方面表现较差。MHT对KPC和OXA-48样酶表现良好，但对NDM、VIM和IMP表现不佳。MDI和RDS易于进行和解释，但对OXA-48样酶、VIM和IMP缺乏敏感性。MHT和MBL Etest通常难以解释。我们建议使用分子检测法对产碳青霉烯酶肠杆菌科进行最佳检测。
A study was designed to evaluate the modified Hodge test (MHT), Mastdiscs ID inhibitor combination disks (MDI), Rosco Diagnostica Neo-Sensitabs (RDS), metallo-beta-lactamase (MBL) Etest, and in-house multiplex PCR for the detection of well-characterized carbapenemase-producing Enterobacteriaceae. One hundred forty-two nonrepeat clinical isolates of carbapenemase-producing Enterobacteriaceae (including Klebsiella spp., Escherichia coli, Citrobacter freundii, and Enterobacter spp.) obtained from the SMART worldwide surveillance program during 2008 to 2009 were included. These included 49 KPC-, 27 NDM-, 19 VIM-, 14 OXA-48-like enzyme-, and 5 IMP-producing isolates and 28 carbapenem-resistant, carbapenemase-negative isolates. The manufacturer's instructions were followed for MDI, RDS, and MBL Etest and CLSI guidelines for MHT. A multiplex PCR was designed to detect KPC, NDM, VIM, IMP, and OXA-48-like carbapenemases. Overall, the sensitivity and specificity were 78% and 93% for MDI, 80% and 93% for RDS, 58% and 93% for MHT, and 55% and 100% for MBL Etest, respectively. The PCR had 100% sensitivity and specificity. MDI and RDS performed well for the detection of KPCs and NDMs but poorly for VIMs, IMPs, and OXA-48-like enzymes. MHT performed well for KPCs and OXA-48-like enzymes but poorly for NDMs, VIMs, and IMPs. MDI and RDS were easy to perform and interpret but lacked sensitivity for OXA-48-like enzymes, VIMs, and IMPs. MHT and MBL Etest were often difficult to interpret. We recommend using molecular tests for the optimal detection of carbapenemase-producing Enterobacteriaceae.