| ObjectiveCentral venous catheter(CVC)is widely used in the treatment of critically ill patients.Catheter-related bloodstream infection(CRBSI)is one of the common complication for CVC catheter patients.Inappropriate and unreasonable treatment is extremely apt to cause sepsis(Sepsis)or septic shock(SS).The occurrence of these diseases is a series of serious systemic responses caused by the infection of CVC related pathogens,and the fatality rate very high.This study investigated the epidemiological characteristics and bacterial biological characteristics of CRBSI and analyzed the correlation between pathogenic virulence genes and infection by retrospective analysis of large samples of CVC catheter invaders in specific areas,providing a biological basis for the prevention and treatment of CRBSI.Methods1.The epidemiological characteristics and bacterial biological characteristics of CRBSI in 16,841 clinical cases were retrospectively analyzed.,Hospital information system(HIS),laboratory information system(LIS)and SPSS19 software were used to analyze the incidence of CRBSI,pathogenic microorganisms,influencing factors and so on.2.The inpatients in the ICU were divided into the group of indwelling CVC catheter(experimental group)and the group of non-indwelling CVC catheter group(control group).The virulence gene expression differences of the six types of infectious pathogens were analyzed by RT-PCR.Statistical analysis was performed using Graphpad prism 6.0.3.Comparative analysis of peripheral venous blood from SS patients with CRBSI who have a CVC catheter in the ICU(experimental group)(control group),and ACE rs4291 and rs4646994 polymorphisms were detected by using polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP).TheKaplan-Meier survival curve was employed to evaluate association between ACE polymorphism and patient survival rate,meanwhile univariate and multivariate methods were used to assessment the risk factors for SS.Result1.Epidemiological characteristics and bacterial biological characteristics of16,841 CVC catheterists CRBSI:(1)The results showed that the total number of CVC tubes increased year by year;during 2012 to 2015,the incidence of CRBSI was 7.9 /thousand catheter day,7.6 / thousand catheter days,6.9 / thousand catheter days,6.4 / thousand catheter days,respectively.However,the CRBSI incidence decreased year by year.(2)CRBSI related factors: patients with a variety of complications(88%),catheter control sensor compliance(5.4(4.2%),poor self-management(2.1%),and other factors(0.3%).(3)CRBSI pathogens: 16,507 cases of single pathogen infection,331 cases of double infection,3 cases of triple infection;total separation of pathogens 16,905 strains,Gram-positive bacteria(G + bacteria)8,709(51.4%),Gram-negative bacteria(G-bacteria)7,875(46.7%),fungal 321(1.9%).(4)The comprehensive analysis showed that there were 10 types of infectious pathogens of CRBSI in CVC catheter patients in this region: Enterococcus(16.5%),Acinetobacter baumannii(15.4%),Klebsiella pneumoniae(11.2%),Pseudomonas aeruginosa(10.5%),Escherichia coli(9.6%),Staphylococcus epidermidis(3.0%)and other six categories.2.The experimental virulence gene analysis of 6 types of infection-causing pathogens,compared with the control group,the experimental groups:Infection-related genes esP,gelE,cylA,ACE of Enterococcus,infection-related genes baP,ompA,csuA of Acinetobacter baumannii,infection-related genes iroN,htrA of Klebsiella pneumoniae,infection-related genes exoS,exoT,exoU,exoY of Pseudomonas aeruginosa,the infection-related gene eaeA of Escherichia coli,the infection-related genes icaA,U43366 of Staphylococcus epidermidis,and other virulence gene expression levels were higher,and the difference was statistically significant(P<0.01).3.The comparative analysis of ACE gene polymorphism between the two groups showed that the alleles(Allele)and genotype frequencies(GF)of ACE rs4291 and rs4646994 were significantly different(P <0.05).The frequency of TT genotype andthe frequency of DD genotype of rs4646994 were significantly higher in the experimental group than that in the control group(P <0.05).The results of ACE cell activity showed that AT and TT genotype(TT> AT)were significantly higher than AA genotype in experimental group and control group,while DD genotype was higher than DI and II genotype(DI> II)There is a significant decline;Kaplan-Meier survival curve assessment showed that SS patients with TT or DD genotype had a higher lethality rate of 7 d-30 d days than non-carriers;SS risk factors of single-variable and multivariate analysis showed that low-grade organ failure(SOFA)score,rs4291,serum ACE and rs4646994 and other factors were higher risk and adverse prognosis of SS patients.ConclusionInfective pathogens of CRCSI in CVC catheter patients in this region are mainly composed of 6 kinds of enterococci,Acinetobacter baumannii,Klebsiella pneumoniae,Pseudomonas aeruginosa,Escherichia coli and Staphylococcus epidermidis.The virulence gene analysis of pathogens showed that the high expression level of infection-associated virulence genes in pathogens of CVC catheters may be related to the occurrence of infection.Among the 16 virulence genes with high expression,there is a clear correlation between ACE gene and SS.This result indicates that ACE virulence gene may become an important clinical predictor. |
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