The Study On Risk Factors,Molecular Epidemiology And Drug Resistance Genes Of Carbapenem-resistant Klebsiella Pneumoniae Isolated From Jiangxi Provincial Hospitals

Objective:To study the molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae（CRKP）in hospitals in Jiangxi Province,determine the main genotypes of CRKP isolated in this area.Discuss the mechanism of CRKP resistance in clinical isolation.To investigate the main risk factors of the Klebsiella pneumoniae isolates were resistant to carbapenemMethods:1.80 CRKP strains isolated from Jiangxi Provincial Hospital from March 2016 to March 2017.The antimicrobial susceptibility was determined by minimal inhibitory concentration.2.The main genotype was determined by Eric-PCR and Multiple Locus Sequence Typing.Analysis mainstream genotypes of CRKP isolated from Jiangxi Provincial Hospital and the distribution of their departments.3.Carbopenease and extended-spectrumβ-lactamase（ESBLs）resistant genes were detected by polymerase chain reaction and positive genotypes were confirmed by DNA sequencing.4.We retrospectively collected data on CRKP-infected persons living in the wards of some hospitals in Jiangxi Province from March 2016 to March 2017.We analyzed the infection of Klebsiella pneumoniae isolates were resistant to carbapenem by univariate chi-square test and multivariate logistic regression model.Results:1.ICU admission,surgery,and urinary catheterization are independent risk factors for the clinical isolation of Klebsiella pneumoniae that resistant to carbapenem antibiotics.2.The clinically isolated CRKP strains have severe drug resistance,and the resistance rates to ertapenem,imipenem and meropenem are 77.5%,72.6%and29.5%,respectively.All of them are resistant to cefoxitin.3.The main genotype 80 isolates of CRKP is ST11,accounting for 28.75%（23/80）.Mainly distributed in intensive medicine and burn and plastic surgery,and presents the trend of cloning.The second most common genotype is ST375 and ST15.4.The carbapenemase-resistant genes detected by CRKP were mainly bla _KPC and bla_IMP.Theβ-lactamase-resistance genes were mainly bla_TEM and bla_SHV.Conclusions:ST11 type is the main genotype of carbapenem-resistant Klebsiella pneumoniae in hospitals in Jiangxi Province,and its drug resistance is serious;multiple drug resistance genes are detected and there is cloning and transmission;We should pay special attention to the clinical work:urinary catheterization,post-operative care,ICU hospitalization protection and rational use of anti-fungal antibiotics.