Hegazy Eman E, Bahey Marwa Gamal, Abo Hagar Alaa Mohammed, Elkholy Amira Abdelgalil, Mohamed Esraa A
Department of Medical Microbiology and Immunology, Faculty of Medicine, Tanta University, Tanta, Egypt.
Department of Anesthesiology, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.
Infect Drug Resist. 2022 Oct 31;15:6331-6342. doi: 10.2147/IDR.S385294. eCollection 2022.
Ventilator-associated pneumonia (VAP) caused by carbapenem-resistant gram-negative bacteria has been proven to be an escalating public health challenge in Egypt owing to its high mortality rate and raised health care costs.
Detection of carbapenem-resistant gram-negative bacilli among VAP patients, genotypic identification of carbapenemase genes in the isolated strains with evaluation of their impact on patient outcome and detection of carbapenemase-producing enterobacterales by MASTDISCS combi Carba plus disc system.
Broncho-alveolar lavage fluid (BALF) and endotracheal aspirate were collected aseptically from clinically suspected VAP patients. Pathogen identification and antibiotic sensitivity testing were done. Carbapenemase-encoding genes ( , , and ) were tested by PCR in all carbapenem-resistant gram-negative isolates. Performance of MASTDISCS combi Carba plus in isolated Enterobacterales was assessed in relation to the PCR results.
Eighty-three carbapenem-resistant gram-negative isolates were detected. The most frequent pathogens were and representing 34.9%, 20.5% and 18.1%, respectively. was the predominant gene. Patients with persistent mechanical ventilation less than 15 days and infection were significantly associated with a higher death rate. MAST-Carba plus had the highest sensitivity, specificity, positive and negative predictive values for detecting OXA-48 carbapenemases representing 81.8%, 92.5%, 75% and 94.9%, respectively.
Worse outcome in VAP patients was associated with carbapenem-resistant gram-negative bacilli. MASTDISCS combi Carba plus is an efficient simple method for identification of different carbapenemases among enterobacterales.
耐碳青霉烯类革兰氏阴性菌引起的呼吸机相关性肺炎（VAP）因其高死亡率和增加的医疗成本，已被证明是埃及日益严峻的公共卫生挑战。
检测VAP患者中耐碳青霉烯类革兰氏阴性杆菌，对分离菌株中的碳青霉烯酶基因进行基因分型，评估其对患者预后的影响，并通过MASTDISCS组合Carba plus圆盘系统检测产碳青霉烯酶的肠杆菌科细菌。
从临床疑似VAP患者中无菌采集支气管肺泡灌洗液（BALF）和气管内吸出物。进行病原体鉴定和抗生素敏感性测试。对所有耐碳青霉烯类革兰氏阴性分离株进行PCR检测碳青霉烯酶编码基因（blaKPC、blaNDM和blaOXA-48）。根据PCR结果评估MASTDISCS组合Carba plus在分离的肠杆菌科细菌中的性能。
检测到83株耐碳青霉烯类革兰氏阴性分离株。最常见的病原体分别是鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌，分别占34.9%、20.5%和18.1%。blaOXA-48是主要基因。持续机械通气少于15天和鲍曼不动杆菌感染的患者死亡率显著更高。MAST-Carba plus检测OXA-48碳青霉烯酶的敏感性、特异性、阳性和阴性预测值最高，分别为81.8%、92.5%、75%和94.9%。
VAP患者预后较差与耐碳青霉烯类革兰氏阴性杆菌有关。MASTDISCS组合Carba plus是一种高效简便的方法，用于鉴定肠杆菌科细菌中的不同碳青霉烯酶。
