Epidemic Status Of Enterobacter Cloacae In A Tertiary Hospital And The Elimination Of Resistant Plasmids Of Scutellaria Baicalensis Etc.to Carbapenem-resistant Enterobacter Cloacae

Objective To investigate the clinical distribution and antibiotic resistance of Enterobacter cloacae isolated from a tertiary hospital in Gansu Province from 2017 to 2019;and to study the effects of Scutellaria baicalensis,Coptis chinensis and Rheum emodito on the elimination of resistant plasmids in carbapenem-resistant Enterobacter cloacae,in order to provide a new idea for clinical treatment of multi-drug-resistant bacteria infection.Methods Retrospective analysis of the surveillance results of antibiotic resistance of Enterobacter cloacae isolated from 2017 to 2019 in the hospital;detection of carbapenemases by modified carbapenem inactivation method combined with ethylene diamine tetraacetic acid carbapenem inactivation method test;transformation test combined antibiotics sensitivity test to detect the existence of resistant plasmid in the strain;determination of minimal inhibitory concentration of drugs by broth dilution method;screening of plasmid elimination strains by plate photocopying culture.The data were analyzed by WHONET5.6 and SPSS19.0,and the difference was statistically significant with p<0.05.Results From 2017 to 2019,a total of 393 strains of Enterobacter cloacae were isolated,accounting for 3.88%(393/10128);most strains of Enterobacter cloacae were isolated from sputum specimens,accounting for 33.33%;Enterobacter cloacae is mainly distributed in burn department and intensive care unit,accounting for 14.50% and 12.98%,respectively;the distribution of Enterobacter cloacae is different in patients of different ages;the resistance rate of Enterobacter cloacae to carbapenems antibiotics is increasing year by year.A total of 40 strains of carbapenem-resistant Enterobacter cloacae were isolated in this hospital,and the detection rate increased year by year.Most strains of carbapenem-resistant Enterobacter cloacae were isolated from sputum specimens,accounting for 30.0%.Carbapenem-resistant Enterobacter cloacae is mainly distributed in burn department and intensive care unit,accounting for 22.5% and 22.5%,respectively.The resistance rate of carbapenem-resistant Enterobacter cloacae against polymyxin B and amikacin was low,but the resistance rate to other 13 commonly antibiotics were high,which were more than 50.0%.A total of 16 strains of carbapenem-resistant Enterobacter cloacae were isolated in 2019,of which 10 strains produced metallo-β-lactamases and 6 strains did not produce carbapenemases.Carbapenem-resistant Enterobacter cloacae was treated with Scutellaria baicalensis and Coptis chinensis for 24 hours,48 hours and 72 hours,respectively,and the elimination rates of resistant plasmids were 0,0.5%,1.5% and 0,1.0%,1.5%,respectively and the elimination rate of resistant plasmids increased with the prolongation of herbal medicine action time,but by Fisher test,p > 0.05,the change trend was not statistically significant.The elimination rate of Rheum emodito to its resistant plasmid was 0.Conclusion The isolation rate of Enterobacter cloacae is different in different clinical specimens in this hospital,and most strains of Enterobacter cloacae were isolated from sputum specimens.Enterobacter cloacae is mainly distributed in burn department and intensive care unit.The isolation rate of carbapenem-resistant Enterobacter cloacae is increasing year by year,which makes it very difficult to treat this bacterial infection in clinic.In this study,Scutellaria baicalensis and Coptis chinensis could eliminate the resistant plasmid of carbapenem-resistant Enterobacter cloacae,while Rheum emodito had no effect on the resistant plasmid of Enterobacter cloacae.