CAJ | 학술논문

目的：本研究旨在探讨自动细菌鉴定药敏仪器对碳青霉烯非敏感肺炎克雷伯菌株的检测效果，并对其实用性、可靠性做出初步评价。方法采用改良Hodge试验对菌株进行产碳青霉烯酶筛选，同时与常规药敏实验筛选的可能产碳青霉烯酶实验菌株对照，对可疑菌株进行相关耐药基因PCR扩增、测序，以此结果作为标准来判断上述试验的敏感性和特异性。结果研究期间临床共检出87株可疑产碳青霉烯酶肺炎克雷伯菌菌株，经Hodge试验初筛、PCR扩增证实产KPC酶的菌株40株，待测序确认6株；无VIM和IMP基因型；VITEK2专家系统提示碳青霉烯酶表型的敏感性87.0%，特异性92.7%。结论 VITEK2自动药敏鉴定仪因其对低水平耐药的产碳青霉烯酶菌株检测效果欠佳，敏感性和特异性不高，在筛选产碳青霉烯酶菌株时需谨慎使用。
목적：본연구지재탐토자동세균감정약민의기대탄청매희비민감폐염극뢰백균주적검측효과，병대기실용성、가고성주출초보평개。방법채용개량Hodge시험대균주진행산탄청매희매사선，동시여상규약민실험사선적가능산탄청매희매실험균주대조，대가의균주진행상관내약기인PCR확증、측서，이차결과작위표준래판단상술시험적민감성화특이성。결과연구기간림상공검출87주가의산탄청매희매폐염극뢰백균균주，경Hodge시험초사、PCR확증증실산KPC매적균주40주，대측서학인6주；무VIM화IMP기인형；VITEK2전가계통제시탄청매희매표형적민감성87.0%，특이성92.7%。결론 VITEK2자동약민감정의인기대저수평내약적산탄청매희매균주검측효과흠가，민감성화특이성불고，재사선산탄청매희매균주시수근신사용。
Objective To evaluate the effect of automated bacterial identification system to identify carbapenemases in Klebsiella pneumoniae isolates and to make a preliminary evaluation of its practicality and reliability. Methods Total of 87 K. pneumoniae isolates with reduced susceptibility to carbapenems were evaluated. Antimicrobial susceptibility was performed by VITEK2. The carbapenemase resistance phenotype of the isolates resistant to carbapenem was screened by modified Hodge test and identified by VITEK2 automated microbial identification and susceptibility instrument. The carbapenemase-encoding genes were identified by PCR and amplicon sequencing. Results Among 87 isolates, 40 isolates were determined as KPC positive by PCR, 6 isolates were waiting for confirmation by sequencing. There was no VIM or IMP gene. Based on the results of PCR, the sensitivity and specificity value for “flagging” a likely carbapenemase was 87.0% and 92.7% by VITEK 2, respectively. Conclusions The sensitivity and specificity of VITEK2 to identify the carbapenemases was not high, due to its poor detection for low-level resistant carbapenemase isolates. This means the method should be used cautiously.