<link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/css/video-js.min.css?v=1"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/base.css?v=5"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/index.css?v=35"><link rel="stylesheet" href="https://ysz-web.yxj.org.cn/live/dist/static/base/index.css?ysz_v=2.0"><script src="https://studioyszimg.yxj.org.cn/js/dsbridge.js?v=13" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/dsBridge/main.js?v=26" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/base/fun.js?ysz_v=3" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/js/nativeToWeb.js?v=1" type="text/javascript"></script><div id="ysz-header" style="margin:0;overflow:hidden;"><h1 style="font-size:24px;line-height:1.8;color:#333333;word-wrap:break-word;">肠杆菌目细菌碳青霉烯酶实验室检测和临床报告规范专家共识</h1><h2 style="font-size:16px;color:#999999;word-wrap:break-word;"><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">2022-05-07</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">原创:检验视界网</em></h2></div><p style=";margin-bottom:0;text-align:right"><span style="font-size:12px;font-family:&#39;微软雅黑&#39;,&#39;sans-serif&#39;;color:#888888;background:white">仅供医学专业人士阅读参考</span></p><p><br/></p><p style="padding: 0px; max-width: 100%; min-height: 1em; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">1.CRE的定义</span></strong></p><p style="padding: 0px; max-width: 100%; min-height: 1em; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 15px;"><strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></strong></span></p><p style="padding: 0px; max-width: 100%; min-height: 1em; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">美国疾病预防控制中心关于CRE的定义<sup> [5]</sup>为满足以下任意一个条件:</span></p><p style="padding: 0px; max-width: 100%; min-height: 1em; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">①对亚胺培南、美罗培南、厄他培南或多利培南任何一种碳青霉烯类耐药者;对于天然对亚胺培南敏感性降低的细菌(如摩根菌属、变形杆菌属和普罗威登菌属等),需参考除亚胺培南外的其他碳青霉烯类抗菌药物的药敏结果。</span></p><p style="padding: 0px; max-width: 100%; min-height: 1em; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">②产生碳青霉烯酶。</span></p><p style="padding: 0px; max-width: 100%; min-height: 1em; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></p><p style="padding: 0px; max-width: 100%; min-height: 1em; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">2. CRE的耐药机制</span></strong></p><p style="padding: 0px; max-width: 100%; min-height: 1em; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 15px;"><strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></strong></span></p><p style="padding: 0px; max-width: 100%; min-height: 1em; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">产生碳青霉烯酶是肠杆菌目细菌对碳青霉烯类药物耐药最主要的机制 [6]。按照Ambler分子分类方法,碳青霉烯酶可分为A、B和D三类。A类为丝氨酸碳青霉烯酶,以blaKPC(blaKPC-2-blaKPC- 55)、 blaSME(blaSME-1-blaSME-5)、blaIMI(blaIMI-1-blaIMI- 18)、blaNMC和blaGES(blaGES-1-blaGES- 43)型 为 主 ;B 类 为 金 属 β 内 酰 胺 酶 , 以 blaN D M (blaNDM- 1-blaNDM-29)、blaIMP(blaIMP-1-blaIMP- 85)、 blaVIM(blaVIM-1-blaVIM-69)、blaGIM(blaGIM-1-blaGIM-2)和blaSPM型为主;D类为OXA-48型丝氨酸碳青霉烯酶,以blaOXA-181和blaOXA-232为主。除产生碳青霉烯酶外,少数菌株对碳青霉烯类药物耐药的机制是产生超广谱β内酰胺酶和/或AmpC酶合并外膜孔蛋白表达下调或缺失。</span></p><p style="padding: 0px; max-width: 100%; min-height: 1em; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 15px;"><br/></span></p><p style="margin: 0px; padding: 0px; max-width: 100%; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">3 碳青霉烯酶分布特征</span></strong></p><p style="margin: 0px; padding: 0px; max-width: 100%; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;">不同国家、不同地区、不同医院、不同人群以及不同细菌所产的碳青霉烯酶种类均有差异<sup> [7-9]</sup>。我国临床分离的CRE菌株产生的碳青霉烯酶以KPC和NDM型为主,少数菌株产生OXA-48、 IMP和VIM型碳青霉烯酶 <sup>[10-12]</sup>。KPC-2型酶为KPC型碳青霉烯酶最主要的亚型,NDM-1和NDM-5是NDM型金属酶中最主要的亚型,而OXA-181和OXA-232型酶是OXA-48型碳青霉烯酶中最主要的亚型。CHINET中国<span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">细菌耐药监测网对2018年收集自全国39所医院935株CRE菌株的研究结果显示,产KPC、NDM和OXA-48型碳青霉烯酶菌株所占比例分别为51.6%(482/935)、35.7%(334/935)和7.3%(68/935),其中少数菌株产碳青霉烯酶复合酶。儿童和成人患者中分离的碳青霉烯类耐药菌株产生的碳青霉烯酶型别有所差异,儿童患者分离的碳青霉烯类耐药肺炎克雷伯菌主要产生KPC、NDM和OXA-48型碳青霉烯酶,而成人患者分离株主要产KPC型碳青霉烯酶;但儿童和成人患者分离的碳青霉烯类耐药大肠埃希菌主要产生NDM型金属β内酰胺酶。</span><br/></p><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><p style="margin: 0px; padding: 0px; max-width: 100%; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 15px;"><strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-title-one" style="margin: 0px; padding: 0px; max-width: 100%; font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left; box-sizing: border-box !important; overflow-wrap: break-word !important;">4.&nbsp;碳青霉烯酶检测的临床意义</span></strong></span></p><p style="margin: 0px; padding: 0px; max-width: 100%; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">由于不同种类的抗菌药物对产生不同碳青霉烯酶菌株的体外抗菌活性不同,准确、快速地对CRE产生的碳青霉烯酶进行检测并分型,对于临床抗感染治疗的精准用药和医院感染预防控制具有重要的价值<sup> [13-15]</sup>。如目前刚上市的抗菌新药头孢他啶-阿维巴坦<sup> [16-17]</sup>,对产KPC和OXA-48型丝氨酸碳青霉烯酶菌株具有高度抗菌活性,但对产金属β内酰胺酶菌株无抗菌活性。目前处于临床研究阶段的美罗培南-韦博巴坦(meropenem-vaborbactam)<sup> [18-19]</sup>和亚胺培南-雷利巴坦(imipenem-relebactam)<sup> [20]</sup>,对产KPC型碳青霉烯酶菌株具有高度抗菌活性,但对产金属β内酰胺酶和D类OXA-48型碳青霉烯酶菌株无抗菌活性。同时,尚有多种新型碳青霉烯酶抑制剂正处于临床研究阶段,包括enmetazobactam<sup> [21]</sup>、taniborbactam<sup> [22-24]</sup>和齐达巴坦(zidebactam)<sup> [25-27]</sup>等。同时,实验室亦可根据不同碳青霉烯酶的特征,如金属β内酰胺酶不能水解氨曲南,KPC型碳青霉烯酶的活性可被阿维巴坦、韦博巴坦或雷利巴坦抑制,被克拉维酸弱抑制,通过开展联合药敏试验制定精准的抗感染治疗方案<sup> [28-29]</sup>。目前已上市及处于临床研究阶段的不同碳青霉烯酶抑制剂的抑酶活性见表1(表1内容参考文献)</span><br/></p><p style="padding: 0px; max-width: 100%; min-height: 1em; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; 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overflow-wrap: break-word ; visibility: visible ; width: 677px ;"/></p><p style="padding: 0px; max-width: 100%; min-height: 1em; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; white-space: normal; background-color: rgb(255, 255, 255); text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C017A98C8729275C72E32E4CD.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; visibility: visible ; width: 677px ;"/></p><p style="padding: 0px; max-width: 100%; min-height: 1em; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; white-space: normal; background-color: rgb(255, 255, 255); text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C017A98C8782853B95D0A3ECB.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; visibility: visible ; width: 677px ;"/></p><p style="padding: 0px; max-width: 100%; min-height: 1em; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; white-space: normal; background-color: rgb(255, 255, 255); text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C017A98C87BB04BEA1EDCAE17.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; visibility: visible ; width: 677px ;"/></p><p style="padding: 0px; max-width: 100%; min-height: 1em; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; white-space: normal; background-color: rgb(255, 255, 255); text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C017A98C88085F54409C09E03.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; visibility: visible ; width: 677px ;"/></p><p style="padding: 0px; max-width: 100%; min-height: 1em; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; white-space: normal; background-color: rgb(255, 255, 255); text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C017A98C88541749D5C5D2781.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; visibility: visible ; width: 677px ;"/></p><p style="padding: 0px; max-width: 100%; min-height: 1em; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; white-space: normal; background-color: rgb(255, 255, 255); text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C017A98C88DBC91B85475556A.jpg" alt="图片" style="margin: 0px; padding: 0px; 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