产碳青霉烯酶肠杆菌科细菌检测方法研究进展

抗生素的不合理使用使得细菌耐药性快速产生及传播，细菌耐药性已然成为重大公共卫生问题。碳青霉烯类抗生素在临床治疗中表现良好，常作为治疗多重耐药菌感染的最后一道防线，碳青霉烯耐药菌的出现对公共卫生安全产生了极大的威胁。产碳青霉烯酶是碳青霉烯耐药菌耐药的主要机制，因此，对产碳青霉烯酶肠杆菌科细菌的检测至关重要。目前，对于碳青霉烯酶的检测手段以表型检测和分子生物学检测方法为主。表型检测一般易于操作，成本低廉，便于在临床进行，但在检测效率和检测用时方面差强人意。分子生物学及其他新型技术在保持高特异性和敏感性的基础上能做到快速、高通量检测，但试验检测的成本高，需专业设备和人员，部分技术在碳青霉烯酶检测领域仍有待开发。当前，多种碳青霉烯酶的检测方法可针对不同的需求和目的，并没有一项检测能满足所有情况。进行检测时，试验所需时间、操作难度、经济成本等都需列入考量，应根据实际情况选择合适的检测方法。笔者通过结合当前背景，归纳总结产碳青霉烯酶肠杆菌科细菌的检测方法，从试验特异性与敏感性、可操作性、检测时间、试验成本等方面分析比较各个方法特点，以期为之后新的检测方法的开发及现有方法的改良研究提供切入点，为临床监测与检测方案的制定和实行提供思路。

Research Progress on the Detection Methods of Carbapenemase-producing Enterobacteriaceae

The overuse and misuse of antibiotics contributed to the accumulative emergence of antibiotics resistance,which has been deemed as a major threat to the public health.Among the existing antibiotics,carbapenems are often considered as the last escort against infection caused by the multi-drug resistant (MDR) bacteria. The emergence of carbapenem-resistant bacteria poses a great threat to public health safety.The production of carbapenemases is the main mechanism for those carbapenem-resistant (CR) Enterobacteriaceae,consequently the detections of carbapenemases is of importance in the diagnosis of CR bacterial infection.The detection of carbapenemases mainly depend on phenotypic methods and molecular methods.Phenotypic detections enjoy the benefit of easy-handling,cost-efficiency,and the high feasibility in clinical cases.However,these methods are also less-effctive and tedious.Molecular detections and the newly-developed technologies enable the specific and sensitive detection in a rapid way,yet these methods always call for high expense and professional equipment.Some technologies are still to be developed in the field of carbapenemase detection.Currently,different detection methods are established and refined for particular purposes,and none of them is able to be employed to meet all demands.In practice,the time-consumption,ease of handling and the cost have to be comprehensively considered to select a suitable method which fits the purpose most.In this review,the different detection methods for carbapenemases are summarized and compared from the aspects specificity and sensitivity,operability,time consumption and the cost,providing an integrated view of the current progresses and advances the detection methods for carbapenemases.