PROCENA PERFORMANSI TRIJU FENOTIPSKIH TESTOVA ZA DETEKCIJU KARBAPENEMAZA U ENTEROBAKTERIJAMA
Sažetak
Enterobakterije koje proizvode karbapenemaze (engl. carbapemenase-producing enterobacterales – CPE) predstavljaju značajan terapijski i epidemiološki problem u bolničkom okruženju, posebno na odeljenjima intenzivne nege. Brza identifikacija ovih mikroorganizama od ključnog je značaja. Cilj ove studije bila je procena triju fenotipskih metoda koje se koriste u rutinskoj dijagnostici. Studija je obuhvatila pedeset šest kliničkih izolata enterobakterija rezistentnih na karbapeneme, koji su izolovani kod pacijenata hospitalizovanih u Univerzitetskom kliničkom centru Niš. U pedeset dva izolata potvrđena je produkcija karbapenemaza, a četiri izolata nisu imala gene za karbapenemaze. Genotipska detekcija je sprovedena Multiplex PCR metodom, ispitujući blaKPC (engl. beta-lactamase Klebsiella Pneumoniae carbapensemase), blaVIM (engl. Verona Integron-encoded Metallo-beta-lactamase), blaNDM (engl. New Delhi metallo-beta-lactamase) i blaOXA (engl. Beta lactamase OXA)-48 gene obuhvatile. Fenotipske metode koje su analizirane uključivale su NG-Test Carba 5, RAPIDEC Carba NP test (RCNP) i komercijalni kombinovani disk test (engl. combined disk test – CDT) – KPC, MBL i OXA-48 Confirm Kit: Carbapenemases. Multiplex PCR je pokazao sledeću distribuciju karbapenemaza: dva izolata su bila produktori KPC-a, dvadeset četiri su produkovala NDM, šesnaest je produkovalo OXA-48 enzime, dok je kod deset izolata detektovana istovremena produkcija NDM-a i OXA-48 enzima. Takođe, jedan izolat Enterobacter cloacae identifikovan je kao koproduktor NDM-a, KPC-a i OXA-48 enzima, a jedan izolat Klebsiella pneumoniae istovremeno je produkovao NDM i KPC enzime. Osetljivost (senzitivnost – Se) i specifičnost (Sp) NG-Test Carba 5 iznosile su 98,08% i 100%. Kada je reč o Carba NP testu, Se i Sp su iznosile 90,38% i 100% posle sto dvadeset minuta. U CDT metodi Se i Sp za detekciju metalo-β-laktamaza (engl. metallo-beta-lactamase) pomoću dipikolinične kiseline (engl. docosapentaenoic acid) bile su 80,56% i 100%, dok su za detekciju klase D karbapenemaza pomoću temocilina iznosile 95,65% i 100%. Najbolje rezultate u detekciji specifičnih klasa karbapenemaza pokazali su NG-Test Carba 5 i CDT metoda. Ove metode bi se mogle koristiti za brzu i pouzdanu detekciju karbapenemaza u rutinskoj dijagnostici.
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