Carbapenemase And Risk Factors Of Carbapenem-resistant Enterobacteriaceae

Objectives:To analyze the drug resistance of carbapenem-resistant Enterobacteriaceae(CRE),compare the results of carbapenemase phenotype test and molecular level,aim to clarify the drug resistance of CRE detected in our hospital.The phenotype test results provide a reference for clinical treatment.Check the patient’s and control group’s medical records for risk factor analysis,and select carbapenem-resistant Klebsiella pneumoniae for homology analysis to determine the infection status of CRE in our hospital in 2017,and identify the high-risk departments and high-risk infections.The crowd provides a basis for advancing CRE screening.Methods:Identification and in vitro drug susceptibility testing were performed using VITEK2 Compact,mCIM and eCIM were used to detect whether the drug-resistant bacteria produced carbapenemase,and the carbapenem-resistant gene was amplified by PCR.The phenotypic test results were compared.According to the ratio of 1:1,patients with similar gender ratios and similar ages were selected as the control group.The medical records were reviewed and SPSS was used for risk factor analysis.Homology analysis of carbapenem-resistant Klebsiella pneumoniae was performed using pulsed-field gel electrophoresis(PFGE).Results:From January 2017 to December 2018,a total of 106 strains of CRE strains were collected,including 94 strains of Klebsiella pneumoniae,8 strains of Escherichia coli,3 strains of Enterobacter cloacae,and 1 strain of Citrobacter freundii.Sample sources include sputum(39/106,36.8%),urine(28/106,26.4%),drainage(10/106,9.4%),stool(11/106,10.4%),blood(6/106,5.7%),wound secretion(6/106,5.7%),bile(3/106,2.8%),cerebrospinal fluid(2/106,1.9%)and catheter culture(1/106,0.9%),resistant The bacterium is mainly distributed in the operating departments such as the intensive care unit and neurosurgery.The resistance rate to common antibiotics is above 90%.The resistance rate of ampicillin,cefotaxime,cefuroxime sodium,cefepime,ceftriaxone,piperacillin,etc.is 100%,sulfonamides and tetracyclines.Drug resistance rates were relatively low,at 47.9%and 42.5%.According to phenotypic detection,among 106 strains of CRE,88 strains were produced carbapenemase(83%),of which 72 strains produced serine enzymes(68%),16 strains produced metalloenzymes(15%),and 18 strains of enzyme-free strains.(17%);Compared with PCR amplification results,101 strains were consistent,one of which carried both KPC and NDM resistance genes and showed serine enzyme type,4 strains did not match,and 1 strain was ineffective.The clinical indicators,medical history and medication status of the experimental group and the control group were compared and statistically analyzed.The use of carbapenems,quinolones,antifungals and hormones was dangerous in the two groups.In terms of invasive procedures,gastric tube,urinary catheter,drainage tube,and mechanical ventilation are risk factors.In basic diseases,respiratory diseases,neurological diseases,and traumatic history are risk factors,and in other clinical indicators,infections are other.Drug-resistant bacteria,hypoproteinemia,and anemia are risk factors,and in the individual case of patients,there is a history of transfer.In the multivariate analysis,considering the comprehensive effects of various factors,the results equation retained the seven factors of carbapenems,gastric tube,urinary catheter,mechanical ventilation,hypoproteinemia,transfer,and respiratory diseases,P<0.05.All are risk factors.For homology analysis,carbapenem-resistant Klebsiella pneumoniae can be divided into A～K11 types,mainly type A and type B,and type A is mainly distributed in ICU and EICU.Conclusions:CRE has a high resistance rate to common antibiotics,and the resistance rate of tetracyclines and sulfa antibiotics is low.Clinically,related drugs can be considered when selecting antibiotics.The results of CRE phenotypic test indicated that the bacteria were mainly carbapenemase.Combined with recent research,the corresponding antibiotics could be selected according to whether the bacteria produced enzymes,which provided a reference for clinical drug use.Patients used antibiotics or hormones before detection of drug-resistant bacteria,invasive procedures,respiratory diseases,neurological diseases and trauma as risk factors,multi-factor analysis,carbapenems,gastric tube,urinary catheter,mechanical ventilation,Hypoproteinemia,transfer,and respiratory diseases are independent,risk factors.The PFGE results suggest that there is no hospital-borne explosive infection caused by CRE in 2017,but ICU,EICU and neurosurgery can be seen as high-level departments of drug-resistant infections.At the same time,neonatal infection with resistant bacteria should also attract attention.Therefore,the establishment of a sound CRE screening and hospital supervision system can better avoid the spread and spread of drug-resistant bacteria.