CAJ | 학술논문

目的以EDTA为金属酶抑制剂,比较4种碳青霉烯类抗生素对金属酶筛选的效果.方法从浙江大学附属第二医院收集产金属β内酰胺酶革兰阴性杆菌30株(16株肠杆菌科细菌和14株非发酵菌)、产KPC肠杆菌科9株和产OXA鲍曼不动杆菌10株,用双纸片金属酶筛查试验分析IPM、MEM、PAN和ETP在加入EDTA前后抑菌环直径的变化.结果当以抑菌环直径差值≥5 mm为假定判读标准时,PAN组的敏感度相对较高[66.7％ (20/30)],其次为MEM组[63.3％ (19/30)]和IPM组[60.0％ (18/30)],ETP组最差[43.3％ (13/30)]；当以抑菌环直径差值≥4 mm为假定判读标准时,MEM组和PAN组的敏感度达到80.0％ (24/30).以抑菌环直径差值≥3 mm为假定判读标准时,IPM组和MEM组的敏感度达到90.0％ (27/30),而PAN组和ETP组的敏感度为83.3％ (25/30)；在这3类假定判读标准下,4种抗生素的特异度均达到100％.用金属酶筛查试验筛选16株产金属酶的肠杆菌科细菌,当以5 mm为假定判读标准时,PAN组的敏感度最高[75.0％ (12/16)]；以4mm为假定判读标准时,PAN组的敏感度高达93.8％ (15/16),远高于IPM组[75.0％ (12/16)]、MEM组[68.8％ (11/16)]和ETP组[68.8％ (11/16)].结论以EDTA为抑制剂的金属酶筛查试验,操作简便快捷,特异性高.不推荐使用ETP来筛查金属酶,对于革兰阴性杆菌的金属酶筛选可选择以≥4 mm为判读标准的MEM或PAN纸片；对于肠杆菌科细菌的金属酶筛选试验可选择以≥4 mm为判读标准的PAN纸片；而对于非发酵菌的金属酶筛查试验,不推荐使用PAN.
목적 이EDTA위금속매억제제,비교4충탄청매희류항생소대금속매사선적효과.방법 종절강대학부속제이의원수집산금속β내선알매혁란음성간균30주(16주장간균과세균화14주비발효균)、산KPC장간균과9주화산OXA포만불동간균10주,용쌍지편금속매사사시험분석IPM、MEM、PAN화ETP재가입EDTA전후억균배직경적변화.결과 당이억균배직경차치≥5 mm위가정판독표준시,PAN조적민감도상대교고[66.7％ (20/30)],기차위MEM조[63.3％ (19/30)]화IPM조[60.0％ (18/30)],ETP조최차[43.3％ (13/30)]；당이억균배직경차치≥4 mm위가정판독표준시,MEM조화PAN조적민감도체도80.0％ (24/30).이억균배직경차치≥3 mm위가정판독표준시,IPM조화MEM조적민감도체도90.0％ (27/30),이PAN조화ETP조적민감도위83.3％ (25/30)；재저3류가정판독표준하,4충항생소적특이도균체도100％.용금속매사사시험사선16주산금속매적장간균과세균,당이5 mm위가정판독표준시,PAN조적민감도최고[75.0％ (12/16)]；이4mm위가정판독표준시,PAN조적민감도고체93.8％ (15/16),원고우IPM조[75.0％ (12/16)]、MEM조[68.8％ (11/16)]화ETP조[68.8％ (11/16)].결론 이EDTA위억제제적금속매사사시험,조작간편쾌첩,특이성고.불추천사용ETP래사사금속매,대우혁란음성간균적금속매사선가선택이≥4 mm위판독표준적MEM혹PAN지편；대우장간균과세균적금속매사선시험가선택이≥4 mm위판독표준적PAN지편；이대우비발효균적금속매사사시험,불추천사용PAN.
Objective To evaluate the effect of four carbapenems combined with EDTA for metallobeta-lactamases (MBLs) detection.Methods Thirty MBLs-producing gram-negative bacteria ( 16 strains of Enterobacteriaceae and 14 strains of Non-fermentative),9 KPC-producing Enterobacteriaceae and 10 OXA-producing Acinetobacter baumannii strains were collected from the Second Affiliated Hospital of Zhejiang University.A double disk screening test with EDTA was performed for MBLs detection,comparing the changes of inhibition zone diameter with or without EDTA.Results When the inhibition zone diameter difference of ≥5 nn as standard,the sensitivity of panipenem (PAN) group was relatively high (66.7％,20/30),followed by meropenem group (MEM) (63.3％,19/30) and imipenem (IPM) group (60.0％,18/30),etrapenem (ETP) group was the wont (43.3％,13/30).When the inhibition zone diameter difference of ≥4 mm as standard,the sensitivity of meropenem and panipenem group was 80.0％ (24/30)respectively.When the inhibition zone diameter difference of ≥ 3 mm as standard,the sensitivity of imipenem and meropenem group was 90.0％ (27/30) respectively,while 83.3％ ( 25/30 ) for etrapenem and panipenem group.Specificity of four groups under these three interpretation was 100％ respectively.Results of screening test for 16 MBLs positive strains showed that the sensitivity of panipenem group was the highest (75.0％,12/16).While using ≥ 5 mm as the MBLs positive interpretation,the sensitivity of panipenem group was the highest (75.0％,12/16).While using ≥4 mm as the MBLs positive interpretation,the sensitivity of panipenem group (93.8％,15/16) was much higher than that of imipenem (75.0％,12/16),meropenem (68.8％,11/16) and ertapenem (68.8％,11/16).Conclusions Detection of MBLs with EDTA is easy to operate,and it shows a low false positive rate against gram-negative bacteria.Ertapenem is not recommended to screen for MBLs,the best method for screening for MBL production in gram-negative bacteria is the MEM-EDTA or PAN-EDTA with a breakpoint of ≥4 mm.As for Enterobacteriaceae,PAN-EDTA with a breakpoint of ≥4 mm is better than the other three carbapenems in screening for MBL production,but panipenem is not recommended for MBLs screening tests for nonfermentative gram-negative bacteria.