CAJ | 학술논문

目的：探讨美罗培南联合多种抑制剂检测肺炎克雷伯菌产碳青霉烯酶类型的可行性。方法共收集可疑产碳青霉烯酶的肺炎克雷伯菌菌株87株。采用美罗培南加多种抑制剂包括3-氨基苯硼酸（APBA），二吡啶羧酸（DPA），乙二胺四乙酸钠（EDTA）和氯唑西林（cloxacillin）等试验来检测菌株产碳青霉烯酶的可能类型；以耐药基因PCR扩增、测序结果作为标准来判断上述试验的敏感性和特异性，并与临床常用的改良Hodge试验结果相比较。结果87株试验菌中，经PCR扩增证实产KPC的菌株40株，待测序确认6株；无VIM、IMP等基因型；改良Hodge试验筛选碳青霉烯酶表型的敏感性为100%，特异性为97.6%；美罗培南和APBA联合检测KPC表型的敏感性为100%，特异性为100%；美罗培南和DPA联合检测MBL表型的敏感性为83.3%，特异性为97.5%；美罗培南和EDTA联合检测MBL表型的敏感性为83.3%，特异性为98.8%。结论改良 Hodge 试验敏感性好，特异性不高，只能作为碳青霉烯酶的初步筛选。美罗培南加抑制剂的试验敏感性和特异性较好，尤其是APBA检测KPC方法，临床上可以考虑该方法作为经济、准确检测碳青霉烯酶的方法推广。
목적：탐토미라배남연합다충억제제검측폐염극뢰백균산탄청매희매류형적가행성。방법공수집가의산탄청매희매적폐염극뢰백균균주87주。채용미라배남가다충억제제포괄3-안기분붕산（APBA），이필정최산（DPA），을이알사을산납（EDTA）화록서서림（cloxacillin）등시험래검측균주산탄청매희매적가능류형；이내약기인PCR확증、측서결과작위표준래판단상술시험적민감성화특이성，병여림상상용적개량Hodge시험결과상비교。결과87주시험균중，경PCR확증증실산KPC적균주40주，대측서학인6주；무VIM、IMP등기인형；개량Hodge시험사선탄청매희매표형적민감성위100%，특이성위97.6%；미라배남화APBA연합검측KPC표형적민감성위100%，특이성위100%；미라배남화DPA연합검측MBL표형적민감성위83.3%，특이성위97.5%；미라배남화EDTA연합검측MBL표형적민감성위83.3%，특이성위98.8%。결론개량 Hodge 시험민감성호，특이성불고，지능작위탄청매희매적초보사선。미라배남가억제제적시험민감성화특이성교호，우기시APBA검측KPC방법，림상상가이고필해방법작위경제、준학검측탄청매희매적방법추엄。
Objectives To evaluate the effect of three methods to identify carbapenemases in Klebsiella pneumoniae isolates in order to make a preliminary evaluation of its practicality and reliability. Methods Eighty-seven K. pneumoniae clinical isolates with reduced susceptibility to carbapenems were evaluated. Antimicrobial susceptibility was performed by agar dilution and VITEK 2 respectively. The carbapenemase resistance phenotype of the isolates resistant to carbapenem was identified by the VITEK 2 automated microbial identification and susceptibility instrument, the K-B disk dissemination test, inhibitor tests using APBA, DPA, EDTA, cloxacillin etc. The carbapenemase-encoding genes were identified by PCR and amplicon sequencing. Results Of 87 isolates, 40 isolates were determined as KPC positive by PCR, 6 isolates were waiting for confirmation by sequencing. There were no VIM and IMP gene. Based on the results of PCR, for detecting carbapenemase phenotype, the sensitivity and specificity were as follows: modified Hodge test screening were 100% and 97.6%; meropenem and PBA derivation of the KPC phenotype were 100% and 100%; meropenem and DPA derivation MBL phenotype were 83.3% and 97.5%; meropenem and EDTA derivation MBL phenotype were 83.3% and 98.8%, respectively. Conclusions The sensitivity of modified Hodge experiment is higher but the specificity is lower. This means the method can be used only as a preliminary screening of carbapenemases. The inhibitors tests of carbapenemase activity have high sensitivity and specificity, especially APBA for detecting KPC. Clinicians can consider this method as an economic and accurate method to detect carbapenemases.