Carbapenem-resistant Enterobacterales (CREs) have been recognized as an important threat to global health. CRE cause the majority of the difficult-to-treat infections in health-care settings and are associated with high mortality. Klebsiella pneumoniae carbapenemase (KPC)-producing CREs, in particular Klebsiella pneumoniae, are globally disseminated and responsible for a large number of outbreaks. Development of rapid methods for KPC detection can provide great clinical and epidemiological benefits to prevent KPC dissemination. The aim of this study was to standardize and validate a LC-MS/MS method to detect KPC. This method was also tested against a broad variety of species, including CRE with other carbapenemase genes and the recently reported mcr-1. For validation, 111 isolates with reduced susceptibility to carbapenems were selected (49 KPC-positive and 62 KPC-negative). The presence of four tryptic peptides related to the KPC enzyme was evaluated, and the identification of at least two of them classified the isolate as "KPC-positive." The LTLGSALAAPQR and LALEGLGVNGQ peptides were both detected in 47 of 49 isolates with the blaKPC gene. The other two peptides, GFLAAAVLAR and APIVLAVYTR, were detected in 46 and 19 isolates with the blaKPC gene, respectively. The method correctly classified 47 of 49 KPC-positive and all KPC-negative isolates yielding 96.07% of sensitivity and 100% of specificity. In conclusion, our results demonstrate that the KPC peptide markers were robustly detected by the method which presented high sensitivity and full specificity and therefore can be used as a reliable method to identify this resistance mechanism.

译文

:耐碳青霉烯的肠杆菌(CRE)被认为是对全球健康的重要威胁。在医疗机构中,CRE导致大多数难以治疗的感染,并与高死亡率相关。产生肺炎克雷伯菌的碳青霉烯酶(KPC),特别是肺炎克雷伯菌,在全球传播,并导致大量爆发。快速检测KPC的方法的开发可以提供巨大的临床和流行病学益处,以防止KPC传播。这项研究的目的是标准化和验证检测KPC的LC-MS / MS方法。还针对多种物种测试了该方法,包括带有其他碳青霉烯酶基因的CRE和最近报道的mcr-1。为了进行验证,选择了对碳青霉烯敏感性降低的111个分离株(49 KPC阳性和62 KPC阴性)。评估了与KPC酶有关的四种胰蛋白酶肽的存在,并且鉴定出其中至少两种将分离物归类为“ KPC阳性”。 LTLGSALAAPQR和LALEGLGVNGQ肽均在blaKPC基因的49个分离株中的47个中检测到。另外两个肽GFLAAAVLAR和APIVLAVYTR,分别在blaKPC基因的46个和19个分离物中检测到。该方法正确分类了49个KPC阳性分离株和所有KPC阴性分离株中的47个,可产生96.07%的敏感性和100%的特异性。总之,我们的结果表明,该方法能可靠地检测KPC肽标记物,具有较高的灵敏度和全特异性,因此可作为鉴定该耐药机制的可靠方法。

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