The Study Of Drug-resistant Gene's Distribution On Plasmid Of Klebsiella Pneumoniae In NICU

Objectives To understand the status of environmental colonization of Klebsiella pneumoniae(KP)in neurological intensive care unit(NICU),and detect the genetics characteristics on plasmid of KP from NICU environment and infection patients,and analysis of the relationship betweve the resistance gene of KP plasmid carrying and resistant phenotypes,guiding the clinical application of antibacterial agents and Neurological intensive strengthen the disinfection treatment ward environment,so as to reduce the infection incidence of KP patients in NICU.Methods During January to December 2015,giving infection monitoring to the patients in NICU,at the same time giving Etiology surveillance to the regular living environment and the infection environmental of NICU.Collecting the KP from the environment and infected patients,and detect the clinical drug resistance phenotypes of the collected KP meanwhile keep strains.Inoculating the collected KP into LB broth culture medium,and then using the plasmid kit extracte the plasmid DNA from the KP.Then using the plasmid DNA as template to detecte the ?-lactam,aminoglycosides and quinolone-resistant genes carried by the plasmids in the KP strains by polymerase chain reaction.Results During the period from January 2015 to December 2015,there was no significant difference in the distribution of bacteria in the conventional environment between large and small rooms in the NICU,and one KP was detected.In the NICU ward environment,Gram-positive bacteria accounted for the dominant position,and a small amount of Gram negative bacteria and fungi,the distribution of pathogens in the environment with the infected patients in the detection of pathogens roughly the same,and five strains of KP were detected from the infected environment.During the study 259 patients enrolled,and179 were infected and 31 strains of KP were detected.Inoculating the collected KP strains into LB broth culture medium,and after extracting the plasmid from KP strains,we found the 37 strains of KP all have plasmid.And then detect 21 kinds of drug resistance genes whether on the plasmid.SHV and rmt B resistance genes were detected on all plasmids,and two more resistant genes were on one plasmid,and 8 strains of KP's plasmid Carrying ?-lactam and aminoglycoside-resistant genes at the same time,and the last 23 strains are carrying both ?-lactam,aminoglycosides and quinolone resistance genes.SHV and rmt B resistance genes were also detected in the 6strains of KP's plasmid.There were two more resistance genes were also carried on the plasmid of them.There were more than 5 strains of KP's plasmid carring both ?-lactam and aminoglycoside-resistant genes,and only 1 strains carring the three kinds of genes.Conclusions There were plasmids in the KP were detected in NICU.One plasmid could Simultaneously carry ?-lactam,aminoglycosides and quinolone-resistant genes,but the drug-resistant genes carried by plasmids of the Klebsiella pneumoniae are not directly proportional to the phenotype of KP's clinical manifestations.The plasmids of Klebsiella pneumoniae in NICU carring ?-actam and aminoglycoside-resistant genes at the same time,the SHV and rmt B genes are the most common,and CTX-M genes may be related to the expression of ESBLs phenotype.Meanwhile,most plasmids of Klebsiella pneumoniae strains carring quinolone-resistant genes and mainly are Aac(6 ')-Ib-cr.