摘要
目的探讨采用环介导等温扩增技术(LAMP)检测肺炎克雷伯菌感染患者头孢菌素酶(AmpC)的临床意义。方法选择2020年1月~2020年12月肺炎克雷伯菌重症肺炎伴呼吸衰竭患者116例作为对象,建立肺炎克雷伯菌AmpC基因LAMP反应体系,采用LAMP法检测肺炎克雷伯菌AmpC基因,完成AmpC酶初筛,以改良三维试验确证结果作为“金标准”。根据检测结果分为阳性与阴性组;采用快速血清学方法检测血沉水平,采用免疫比浊法测定两组超敏C反应蛋白(hs-CRP)水平,并完成肺炎克雷伯菌感染患者耐药性分析。结果116例肺炎克雷伯菌重症肺炎伴呼吸衰竭患者经改良三维试验确证检出AmpC酶9例,检出率为7.76%。LAMP检查确诊11例,诊断符合率为96.55%(P>0.05),诊断灵敏度为88.89%,特异度为97.20%;AmpC基因阳性患者血沉、hs-CRP水平高于AmpC基因阴性患者(P<0.05);AmpC酶阳性患者头孢呋辛、头孢西丁、复方新诺明、头孢曲松、阿莫西林/克拉维酸、头孢他啶、哌拉西林/他唑巴坦、头孢吡肟、左旋氧氟沙星、头孢哌酮/舒巴坦、阿米卡星、亚胺培南耐药率高于阴性患者(P<0.05)。结论LAMP用于肺炎克雷伯菌感染患者AmpC酶中具有较高检出率,且与血沉、hs-CRP水平存在紧密的联系,且AmpC酶阳性患者耐药性更高,该检测可指导临床抗菌药物选择。
Objective To investigate the clinical significance of loop-mediated isothermal amplification(LAMP)in the detection of cephalosporinase(AmpC)in patients with Klebsiella pneumoniae infection.Methods A total of 116 patients with severe Klebsiella pneumoniae pneumonia and respiratory failure from January 2020 to December 2020 were selected as the subjects.The Klebsiella pneumoniae AmpC gene LAMP reaction system was established,and the LAMP method was used to detect the Klebsiella pneumoniae AmpC gene,completed the primary screening of AmpC enzyme,and used the improved three-dimensional test to confirm the results as the"gold standard".According to the test results,they were divided into positive and negative groups;rapid serological methods were used to detect erythrocyte sedimentation rate,immunoturbidimetry was used to determine the levels of high-sensitivity C-reactive protein(hs-CRP)in the two groups,and drug resistance in patients with Klebsiella pneumoniae infection was completed.Sexual Analysis.Results In 116 patients with severe Klebsiella pneumoniae pneumonia and respiratory failure,9 cases of AmpC enzyme were confirmed by modified three-dimensional test,and the detection rate was 7.76%.LAMP examination confirmed 11 cases,the diagnostic coincidence rate was 96.55%(P>0.05),the diagnostic sensitivity was 88.89%,and the specificity was 97.20%;ESR and hs-CRP levels in AmpC-positive patients were higher than those in AmpC-negative patients(P<0.05).AmpC enzyme-positive patients with cefuroxime,cefoxitin,co-trimoxazole,ceftriaxone,amoxicillin/clavulanate,ceftazidime,piperacillin/tazobactam,cefepime,levofloxa The drug resistance rates of star,cefoperazone/sulbactam,amikacin and imipenem were higher than those of negative patients(P<0.05).Conclusion LAMP has a high detection rate for AmpC enzyme in patients with Klebsiella pneumoniae infection,and there is a close relationship with erythrocyte sedimentation rate and hs-CRP level,and patients with positive AmpC enzyme have higher drug resistance,which can guide clinical antibiotics choose.
作者
田巍
孟文
TIAN Wei;MENG Wen(Department of Laboratory Medicine,Nanhua Hospital Affiliated to South China University,Hengyang 421002,China)
出处
《中国处方药》
2022年第10期178-180,共3页
Journal of China Prescription Drug
基金
湖南省卫生健康委2020年度科研立项课题(20200964)。
关键词
环介导等温扩增技术
肺炎克雷伯菌感染
头孢菌素酶
临床意义
Loop-mediated isothermal amplification
Klebsiella pneumonia infection
Cephalosporin enzyme
Clinical significance
作者简介
通信作者:孟文,Email:244901388@qq.com。
