The Research Of Using Genexpert Method To Detect Carbapenem-resistant Klebsiella Pneumonia And Escherichia Coli Resistance Genes In A Hospital In Shenyang Region

Objective: Research of drug-resistant trend in Carbapenem-resistant Klebsiella pneumonia and Carbapenem-resistant Escherichia coli,use Gene Xpert method to detect the case of resistant genes,provide experimental basis for guide clinical rational drug use in our hospital.To provide the reference for prevention and control of carbapenems in Carbapenem-resistant Klebsiella pneumonia and Carbapenem-resistant Escherichia coli infection and outbreak in our hospital.Methods: Collect 60 strains of Carbapenem-resistant Klebsiella pneumonia which culture and separation from clinical of shengjing hospital affiliated to China medical university in January 2013-June 2017.60 strains of Carbapenem-resistant Escherichia coli in January 2015-January 2018.Eliminate the repetitive strains from same patients.Use VITEK 2 Compact automatic bacteria identification instrument to identify the bacteria,and Kirby-Bauer method to further determine the preliminary screening of Carbapenem-resistant Klebsiella pneumonia and Carbapenem-resistant Escherichia coli strains.Use Gene Xpert method to detect five kinds of resistant genes(KPC?NDM?IMP-1?OXA-48?VIM).Results: In our hospital,carbapenem-resistant Klebsiella pneumonia was the most sensitive to amikacin,up to 78.95%.The sensitivity rates of levofloxacin and ciprofloxacin were 48.28% and 43.10% respectively.The sensitivity rates of gentamicin,tobramycin and cotrimoxazole were 37.93%,35.71% and 29.31% respectively.The sensitivity rate of nitrofurantoin was 5.26%,the intermediary rate was 28.95%.The sensitive rate of aztreonam,piperacillin/tazobactam,cefotetan,cefepime,ceftriaxone,cefazolin,ampicillin/sulbactam were during 0%-15.52%.The result of Gene Xpert method to detect five kinds of resistant genes were 49 strains carry carbapenemases,accounted for 81.67%.11 strains not carrying carbapenemase,accounted for 18.33%.Among them,carrying a single KPC were 19 strains,accounting for 31.7%;carrying a single NDM were 18 strains,accounting for 30%;carrying a single IMP-1 was1 strain,accounting for 1.7%;both carrying KPC and NDM were 9 strains,accounting for 15%;both carrying KPC and IMP-1 was 1 strain,accounting for 1.7%;At the same time carrying IMP-1,KPC and NDM was 1 strain,accounting for 1.7%.The remaining type of resistance gene was not detected.The MIC of imipenem and whether detected were statistically significant,the strains which detected resistance genes were more resistant to imipenem.There was no significant difference between the number of resistant genes and the prognosis of patients.The carbapenem-resistant Escherichia coli was the most sensitive to tigecycline,up to 100%.The sensitivity rates of amoxicillin / clavulanate and amikacin were 95% and 90% respectively.The sensitivity rate to aztreonam was 48.08%.The sensitivity rates of chloramphenicol and gentamicin were 35.14% and 26.67% respectively.The sensitive rate of other common antibacterials include piperacillin / tazobactam,ciprofloxacin,cotrimoxazole,levofloxacin,tetracycline,ceftazidime,cefepime,cefoperazone / sulbactam,ceftriaxone,cefazolin,ceftizoxime,ampicillin were during 0%-13.33%.Resistance gene detect results show 56 strains carrying carbapenemases,accounting for 93.33%.4 strains not carrying carbapenemase,accounting for 6.67%.The enzyme production resistant strains are all carrying a single NDM,the remaining type of resistance gene was not detected.Conclusion: In our hospital,Carbapenem-resistant Klebsiella pneumonia and Carbapenem-resistant Escherichia coli were multi-drug resistance,the situation is not optimistic.Amikacin,tigecycline,amoxicillin/clavulanate can be selected as a therapeutic drug.The high enzyme production suggesting that drug resistance genes are rapidly spread which should cause clinical and scientific research attention.Gene Xpert method as a rapid gene level detection of new method of infectious pathogens deserves attention.