Clinical Characteristics And Risk Factors Of Carbapenem-Resistant Gram-Negative Bacteria Bloodstream Infection

ObjectiveTo analyze the clinical characteristics and risk factors of carbapenem resistance in Gram-negative bacteria bloodstream infections and to provide evidence for clinical prevention and treatment.MethodsGram-negative bacteria isolated from patients with bloodstream infection in our hospital and related clinical data were collected from,March 2016 to January 2017.All the patients were divided into two groups-carbapenem resistant Gram-negative bacteria(CR-GNB)group and carbapenem sensitive Gram-negative bacteria(CS-GNB)group according to the in vitro carbapenem activity.Pulsed field gel electrophoresis(PFGE)was used to analyze the homology of drug resistant strains.The risk factors of CR-GNB bloodstream infections were performed using multivariate logistic regression analysis.ResultsThe incidence rate of carbapenem resistant Gram-negative bacteria was 18.7%(26/139),with the rates of E.coli,Klebsiella pneumoniae,Acinetobacter baumannii and Pseudomonas aeruginosa were 0(0/59),42.1%(16/38),57.14%(8/14),22.22%(2/9),respectively.16 strains of carbapenem-resistant Klebsiella pneumoniae(CRKP)were divided into A-E clones by PFGE,and type E was the most popular clone(7/16),mainly in the intensive care unit(ICU).Carbapenem-resistant Acinetobacter baumannii(CRAB)had seven clones from A to G.The overall 28-day mortality rate of the CR-GNB group was 50%(13/26),while the CS-GNB group was only 13.3%(15/113).There were statistical differences in gender,department,history of ICU stay,length of hospital stay,PICC catheter between the two groups.With logistic regression analysis,the results showed that history of ICU(OR = 6.869),length of hospital stay(OR = 1.063)were the independent risk factors of CR-GNB bloodstream infections.ConclusionIn order to reduce the incidence of CR-GNB bloodstream infection,we should focus on controlling infections in high incidence departments,strictly control admission and ICU indications and shorten the unnecessary hospitalization time.