Evaluation of PCR-Based Testing for Surveillance of KPC-Producing Carbapenem-Resistant Members of the Enterobacteriaceae Family
Evaluation of PCR-Based Testing for Surveillance of KPC-Producing Carbapenem-Resistant Members of the Enterobacteriaceae Family
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DOI：
10.1128/jcm.02368-08
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发表时间：
2009-10-01
影响因子：
9.4
通讯作者：
Navon-Venezia, Shiri
中科院分区：
文献类型：
--
作者：
Schechner, Vered;Straus-Robinson, Keren;Navon-Venezia, Shiri
携带碳青霉烯酶的肠杆菌科（CRE）碳青霉烯类耐药成员的传播是一种新出现的公共卫生威胁。由于产KPC的克雷伯菌属在我们的三级保健医院是地方性的，我们的目的是评价一种基于PCR的监测试验，用于鉴定产KPC的CRE的直肠携带。我们在2007年5月至12月期间进行了一项监测研究。从已知携带CRE的患者和新发现的携带CRE的患者的接触者中采集直肠拭子。通过培养和bla（KPC）PCR分析对标本进行评价，如果培养了CRE并鉴定出bla（KPC），则将其定义为阳性。通过传代培养、重复PCR和进行水解试验解决了培养和PCR分析之间的不一致结果。还考虑了研究采样前或采样后的阳性CRE培养物。计算灵敏度、特异性和至结果的时间。共纳入755个拭子。记录了735份标本的一致性结果; 51份通过PCR和培养法测定为阳性。20份拭子存在差异; 9份为bla（KPC）阴性，CRE培养阳性，11份为bla（KPC）阳性，CRE培养阴性。重复检测后，共有64份样本被归类为bla（KPC）阳性CRE。PCR检测的敏感性和特异性分别为92.2%和99.6%，培养检测的敏感性和特异性分别为87.5%和99.4%。在研究的最后3个月，PCR的灵敏度提高到96.3%，而培养的灵敏度为77.8%。PCR的结果时间为30 h，CRE培养的结果时间为60 h（阴性）和75 h（阳性）。bla（KPC）PCR检测是监测KPC产生的CRE的有用方法。与培养相比，它的主要优点是产生结果的时间更短，并且可能被证明更敏感。
The spread of carbapenem-resistant members of the Enterobacteriaceae family (CRE) harboring carbapenemases is an emerging public health threat. As KPC-producing Klebsiella species are endemic in our tertiary care hospital, we aimed to evaluate a PCR-based surveillance test for identification of rectal carriage of KPC-producing CRE. We conducted a surveillance study between May and December 2007. Rectal swabs were collected from patients known to harbor CRE and from contacts of newly discovered patients harboring CRE. Specimens were evaluated by culture and by PCR analysis for bla(KPC) and were defined as positive if CRE was cultured and bla(KPC) was identified. Discrepant results between the culture and PCR analysis were resolved by subculturing, repeating the PCR, and performing a hydrolysis assay. Positive CRE cultures prior or subsequent to the time of sampling for the study were also taken into consideration. Sensitivity, specificity, and time to result were calculated. A total of 755 swabs were included. Concordant results were documented for 735 specimens; 51 were positive as determined by both PCR and culture. Discrepancies existed for 20 swabs; 9 were bla(KPC) negative and CRE culture positive, and 11 were bla(KPC) positive and CRE culture negative. After repeat testing, a total of 64 samples were classified as bla(KPC)-positive CRE. The sensitivity and specificity of the PCR analysis were 92.2% and 99.6%, respectively, and those of the culture were 87.5% and 99.4%, respectively. Over the last 3 months of the study, the sensitivity of the PCR improved to 96.3%, versus 77.8% for culture. Time to result was 30 h for the PCR and 60 h (negative) and 75 h (positive) for the CRE culture. bla(KPC) PCR-based testing is a useful method for the surveillance of KPC-producing CRE. Its main advantage over culturing is a shorter time to result, and it may prove to be more sensitive.