Wei Ming, Wang Peng, Wang Shuai, Yang Chunxia, Gu Li
Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.
Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.
J Glob Antimicrob Resist. 2021 Sep;26:272-278. doi: 10.1016/j.jgar.2021.02.036. Epub 2021 Jul 18.
The prevalence of carbapenem-resistant Enterobacterales (CRE) has increased rapidly worldwide in the last two decades. CRE infection poses a huge challenge for today's clinical therapy. Rapid and accurate detection of clinical CRE isolates can avoid inappropriate antimicrobial treatment and reduce mortality. However, existing detection methods are either time consuming, expensive or inaccurate, making them unable to fully meet clinical demands. In this study, the HB&L system was designed to distinguish CRE from carbapenem-susceptible Enterobacterales (CSE), as it can accelerate the growth of bacteria, detect both carbapenemase-producing CRE (CP-CRE) and non-CP-CRE isolates in real time, and provide time-kill curves.
The broth microdilution method and PCR and sequencing were used as the reference methods to identify CRE and carbapenemase-producing Enterobacterales (CPE) isolates, respectively. Three methods for detecting CRE isolates, including the Carba NP test, modified carbapenem inactivation method (mCIM) and HB&L system, were evaluated.
The accuracy of the HB&L system was extremely high with 100% sensitivity and 96.0% specificity at only 6 h of culture time for detecting CRE. Time-kill curves may provide information on effective treatment options for clinicians. This system is superior to the mCIM (20-24 h detection time; 90.6% sensitivity and 96.6% specificity) and Carba NP test (2 h detection time; 85.2% sensitivity and 98.4% specificity), which are only designed to detect CP-CRE.
The HB&L system is promising for wide application for detection of clinical CRE in hospitals.
在过去二十年中，耐碳青霉烯类肠杆菌科细菌（CRE）在全球范围内的流行率迅速上升。CRE感染给当今的临床治疗带来了巨大挑战。快速准确地检测临床CRE分离株可以避免不适当的抗菌治疗并降低死亡率。然而，现有的检测方法要么耗时、昂贵，要么不准确，无法完全满足临床需求。在本研究中，设计了HB&L系统以区分CRE与碳青霉烯类敏感肠杆菌科细菌（CSE），因为它可以加速细菌生长，实时检测产碳青霉烯酶CRE（CP-CRE）和非CP-CRE分离株，并提供时间-杀菌曲线。
采用肉汤微量稀释法以及PCR和测序分别作为鉴定CRE和产碳青霉烯酶肠杆菌科细菌（CPE）分离株的参考方法。评估了三种检测CRE分离株的方法，包括Carba NP试验、改良碳青霉烯灭活法（mCIM）和HB&L系统。
HB&L系统的准确性极高，在培养仅6小时时检测CRE的灵敏度为100%，特异性为96.0%。时间-杀菌曲线可为临床医生提供有效治疗方案的信息。该系统优于仅用于检测CP-CRE的mCIM（检测时间为20 - 24小时；灵敏度为90.6%，特异性为96.6%）和Carba NP试验（检测时间为2小时；灵敏度为85.2%，特异性为98.4%）。
HB&L系统在医院临床CRE检测中具有广泛应用前景。
