Tenover Fred C, Kalsi Rajinder K, Williams Portia P, Carey Roberta B, Stocker Sheila, Lonsway David, Rasheed J Kamile, Biddle James W, McGowan John E, Hanna Bruce
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
Emerg Infect Dis. 2006 Aug;12(8):1209-13. doi: 10.3201/eid1208.060291.
Detecting beta-lactamase-mediated carbapenem resistance among Klebsiella pneumoniae isolates and other Enterobacteriaceae is an emerging problem. In this study, 15 blaKPC-positive Klebsiella pneumoniae that showed discrepant results for imipenem and meropenem from 4 New York City hospitals were characterized by isoelectric focusing; broth microdilution (BMD); disk diffusion (DD); and MicroScan, Phoenix, Sensititre, VITEK, and VITEK 2 automated systems. All 15 isolates were either intermediate or resistant to imipenem and meropenem by BMD; 1 was susceptible to imipenem by DD. MicroScan and Phoenix reported 1 (6.7%) and 2 (13.3%) isolates, respectively, as imipenem susceptible. VITEK and VITEK 2 reported 10 (67%) and 5 (33%) isolates, respectively, as imipenem susceptible. By Sensititre, 13 (87%) isolates were susceptible to imipenem, and 12 (80%) were susceptible to meropenem. The VITEK 2 Advanced Expert System changed 2 imipenem MIC results from >16 ?g/mL to <2 ?g/mL but kept the interpretation as resistant. The recognition of carbapenem-resistant K. pneumoniae continues to challenge automated susceptibility systems.
在肺炎克雷伯菌及其他肠杆菌科细菌中检测β-内酰胺酶介导的碳青霉烯类耐药性是一个新出现的问题。在本研究中，对来自纽约市4家医院的15株blaKPC阳性肺炎克雷伯菌进行了鉴定，这些菌株对亚胺培南和美罗培南的检测结果存在差异，采用了等电聚焦、肉汤微量稀释法（BMD）、纸片扩散法（DD）以及MicroScan、Phoenix、Sensititre、VITEK和VITEK 2自动化系统进行检测。通过BMD检测，所有15株菌株对亚胺培南和美罗培南均为中介或耐药；通过DD检测，有1株对亚胺培南敏感。MicroScan和Phoenix分别报告有1株（6.7%）和2株（13.3%）菌株对亚胺培南敏感。VITEK和VITEK 2分别报告有10株（67%）和5株（33%）菌株对亚胺培南敏感。通过Sensititre检测，有13株（87%）菌株对亚胺培南敏感，12株（80%）对美罗培南敏感。VITEK 2高级专家系统将2株亚胺培南的最低抑菌浓度（MIC）结果从>16 μg/mL改为<2 μg/mL，但仍判定为耐药。对碳青霉烯类耐药肺炎克雷伯菌的识别继续给自动化药敏系统带来挑战。
