Peter S, Lacher A, Marschal M, Hölzl F, Buhl M, Autenrieth I, Kaase M, Willmann M
Institute of Medical Microbiology and Hygiene, University of Tübingen, Elfriede-Aulhorn-Str.6, 72076, Tübingen, Germany,
Eur J Clin Microbiol Infect Dis. 2014 Jul;33(7):1133-41. doi: 10.1007/s10096-014-2059-1. Epub 2014 Jan 23.
Metallo-beta-lactamase (MBL) production in Pseudomonas aeruginosa is a growing issue across the globe. Fast and reliable diagnostic tools are needed for appropriate implementation of infection control measures. In this study we evaluated the performance of three commercial combined disk tests, two EDTA based in-house combined disk tests and the Carba NP test in comparison to molecular detection of MBL genes on 133 meropenem non-susceptible non-duplicate P. aeruginosa clinical isolates. The meropenem/DPA based commercial KPC + MBL-confirm ID kit (Rosco Diagnostica, Denmark) and the MASTDISCS™ ID carbapenemase (Enterobacteriaceae) detection disc set (MAST Diagnostics, UK) showed sensitivities of 31.1 % and 28.8 % and specificities of 69.3 % and 79.6 %, respectively. The total MBL confirm kit (Rosco Diagnostica, Denmark) contains imipenem/DPA and imipenem/EDTA combination disks. Evaluation of the single disk combinations revealed 84.4 % sensitivity and 81.8 % specificity for the imipenem/DPA assay and 86.7 % sensitivity and 51.1 % specificity for the imipenem/EDTA test. Applying both tests simultaneously resulted in a slightly higher sensitivity of 88.9 % but a lower specificity of 48.9 % when compared to the single tests alone. The Carba NP test showed 93.3 % sensitivity and 96.6 % specificity. All phenotypic combined disk tests lacked either sensitivity or specificity for the detection of MBL in P. aeruginosa. The Carba NP test showed excellent test properties, but suffers from drawbacks in handling and high costs. The optimal diagnostic approach needs to be chosen depending on the epidemiological situation, laboratory resources and availability of molecular confirmation tests.
铜绿假单胞菌中金属β-内酰胺酶（MBL）的产生是全球范围内日益严重的问题。为了适当实施感染控制措施，需要快速可靠的诊断工具。在本研究中，我们评估了三种商业联合纸片试验、两种基于乙二胺四乙酸（EDTA）的内部联合纸片试验以及碳青霉烯酶检测试验（Carba NP试验）与133株对美罗培南不敏感且非重复的铜绿假单胞菌临床分离株中MBL基因分子检测相比的性能。基于美罗培南/二吡啶胺（DPA）的商业KPC + MBL确认ID试剂盒（丹麦Rosco诊断公司）和MASTDISCS™ ID碳青霉烯酶（肠杆菌科）检测纸片组（英国MAST诊断公司）的敏感性分别为31.1%和28.8%，特异性分别为69.3%和79.6%。总MBL确认试剂盒（丹麦Rosco诊断公司）包含亚胺培南/DPA和亚胺培南/EDTA联合纸片。对单个纸片组合的评估显示，亚胺培南/DPA试验的敏感性为84.4%，特异性为81.8%；亚胺培南/EDTA试验的敏感性为86.7%，特异性为51.1%。与单独的单个试验相比，同时应用这两种试验导致敏感性略高，为88.9%，但特异性较低，为48.9%。Carba NP试验的敏感性为93.3%，特异性为96.6%。所有表型联合纸片试验在检测铜绿假单胞菌中的MBL时都缺乏敏感性或特异性。Carba NP试验显示出优异的试验性能，但在操作方面存在缺点且成本高昂。需要根据流行病学情况、实验室资源和分子确认试验的可用性选择最佳诊断方法。
