Risk Factor And Resistance Gene Analysis On Pneumonia Infected By MDRPA In ICU

Background and purpose: Pseudomonas aeruginosa, a gram-negative bacteriaopportunistic pathogens, which is a major lethal pathogen in hospital-acquiredpneumonia, has been one of the main pathogens of nosocomial infections. Multi-Drugresistant Pseudomonas aeruginosa (MDRPA) whose resistance rates keep increasingin recent years, tend to have a variety of mechanisms. Caused by MDRPA infectionmay occur in the lungs, abdomen, central nervous system, urinary system, skinwounds, and in the ICU lung infection is most common. Therefore, it is significantfor the prevention and treatment of multi-drug resistant infections that analyze itsresistant gene detection and the risk factors of MDRPA in ICU.We will research the MDRPA in ICU following:First, Collect sputum bacterial etiology and clinical data of ICU patientsMDRPA due to the occurrence of acquired pneumonia in hospital, and the risk factorsanalyzed with its occurrence.Second, test the associated resistance gene in drug-resistant bacteria sputum,explore its resistance genes carrying case.Method: First Affiliated Hospital of Nanchang University in April2013March2014Check each ICU patients diagnosed187cases of hospital-acquired pneumonia(hospital acquired pneumonia, HAP), and will be one of sputum culture is multi-drugresistant Pseudomonas aeruginosa patients intracellular bacteria were104patients forthe study, the results of non-culture of multi-drug resistant Pseudomonas aeruginosaas the control group83patients.1. Collected187cases of patients with sputum samples for culturing andsensitivity to identify and save strains.2. Collected187cases of clinical data, clinical distribution.3. Collected retrospectively controlled studies, clinical risk factors for infection.4. Tested Polymerase chain reaction (PCR) to analyze104cases of MDRPAcollected in the carrying case strains resistant genes.5. Statistical analysis was performed using SPSS13.0. Results:1.104case MDRPA detected has evident resistance to clinical commonly usedfour antibiotics such as cephalosporins, carbapenems, β-lactamase inhibitorcompound preparation and fluoroquinolone, and polymyxin is100%sensitive, andmild sensitive to aminoglycoside antibiotics.2. there is no significant correlation AcrAB-TolC efflux pump in patientshospitalized with the diagnosis of multi-drug resistant infections, but significantdifference in MDRPA (P <0.05), conpared with multi-drug resistant Pseudomonasinfection prior to used carbapenems and quinolone antibiotics and. It’s a risk factorsuse of antibiotics before the infection caused by MDRPA (P <0.05). In invasiveinspection and operation, either endotracheal intubation with mechanical ventilation,mechanical ventilation or tracheostomy, is risk factors of MDRPA hospital-acquiredpneumonia caused (P <0.05)；and there is not statistically significant for whethercan be caused by MDRPA hospital-acquired pneumonia such as central venouscatheter and catheterization.3.81of the104multi-drug resistant Pseudomonas aeruginosa has amplifiedintegrated gene (qacE△1-sul1), accounting for77.89%.47of the total missingchannel gene (oprD2), accounting for45.19%of all the detected specimens.8kinds ofβ-lactamase gene analysis showed that: alkenyl hydrocarbon enzyme gene inOXA-23, OXA-24expression was not detected, the positive of IMP gene representing16.34%, the VIM gene11.53%,the remaining TEM gene68.27%,SHV geneaccounted for39.43%, PER genes accounted for17.31%, the positive of DHA gene inAmpC enzyme genes is39.43%.Conclusion:1. The test results of hospital-acquired pneumonia caused by multi-drug resistantPseudomonas aeruginosa susceptibility in our hospital show that it has a bettersensitivity to polymyxin and aminoglycoside antibiotics. it has a significantlyantibiotic resistance to cephalosporins, carbapenems,β-lactamase inhibitor compoundpreparation and fluoroquinolone.2.For intubation and mechanical ventilation andtracheostomy mechanical ventilation using carbapenems, quinolones alone,or jointuse of antibiotics are the risk factors of multi-drug resistant Pseudomonas aeruginosa caused.hospital-acquired pneumonia.3.In the ICU of our hospital multi-drug resistantPseudomonas aeruginosa carry a variety of β-lactamase gene, the mainly is TEMgene,SHV genes and genes of AmpC gene-based DHA, may be considered as a majordrug-producing bacteria genes.The presence of channel gene (opr D2) exist in theabsence of drug-resistant bacteria phenomenon, but the ratio is not high.