Surveillance Of Antibiotic Resistance Of Klebsiella Pneumoniae And Correlation Analysis Between ESBLs Genes And Mobile Genetic Elements In ESBLs-producing Klebsiella Pneumoniae

Objective: 1.To study the change of antibiotic resistance and the risk factors of Klebsiella pneumoniae infection.2.To investigate the distribution status of ESBLs genes and genetic markers of MGEs in ESBLs-producing Klebsiella pneumoniae and observe their correlation.3.To investigate the genotypes of ESBLs-producing Klebsiella pneumoniae were typed to determine whether there was an outbreak of Klebsiella pneumoniae.Methods: 1.The antibiotic resistance of Klebsiella pneumoniae during 2008-2018 was analyzed retrospectively by WHONET5.6 software,and 582 medical records of clinical inpatients with Klebsiella pneumoniae isolated from July 2017 to June 2018 were analyzed.2.100 non-repetitive ESBLs-producing Klebsiella pneumoniae strains and 100 non-repetitive non-ESBLs-producing Klebsiella pneumoniae strains were collected from hospitalized patients in a class-III general hospital in Guizhou Province.Four kinds of ESBLs genes(SHV-12、TEM-1、CTX-M-125、OXA-1)and eight kinds of genetic markers of MGEs(IntI1、IS26、ISEcp1、merA、tnp513、tnpU、traA、traC)were analyzed by PCR.Then the test results were analyzed by index cluster analysis.3.The genomes of 100 ESBLs-producing Klebsiella pneumoniae strains were typed by ERIC-PCR to analyze the homology among the strains.Results: 1.The detection rate of Klebsiella pneumoniae was high during 2008-2018.During 2008-2018,the resistance rate of Klebsiella pneumoniae to carbapenems was the lowest,the resistance rate of Klebsiella pneumoniae to cephalosporins and other antibiotics ranged from 10% to 60%,and the change of resistance rate of Klebsiella pneumoniae was not obvious.The results of the risk factors of Klebsiella pneumoniae infection showed that the use of indwelling catheter,invasive examination or treatment were risk factors of Klebsiella pneumoniae infection,and the use of indwelling catheter was the independent risk factor.2.The positive rate of ESBLs genes was as high as 100% in ESBLs-producing Klebsiella pneumoniae.The major genotypes of genetic markers of MGEs were IS26,ISEcp1,traA,trbC and intI1.And their positive rate in ESBLs-producing Klebsiella pneumoniae were higher than those in non-ESBLs-producing Klebsiella pneumoniae(P<0.05).The detection rate of ESBLs genes and genetic markers of MGEs in ESBLs-producing Klebsiella pneumoniae were significantly higher than that in non-ESBLs-producing Klebsiella pneumoniae(P<0.05).There was an association between SHV-12,OXA-1 and tnpU,tnp513,merA,intI1.There was also an association between TEM-1,CTX-M-125 and ISEcp1,IS26,traA.3.Among 99 strains of ESBLs-producing Klebsiella pneumoniae amplified bands and were divided into 93 types,named A1-A93,of which 3 strains were A1,2 strains were A2,A3,A4 and A5.And 88 other types showed unique DNA profiles.Conclusion: 1.The antibiotics use of Klebsiella pneumoniae should be further improved,and it should be strengthened the surveillance of antibiotic resistance of Klebsiella pneumoniae in hospital.2.The risk factors of Klebsiella pneumoniae infection are the use of indwelling catheter,invasive examination or treatment.And the use of indwelling catheter is an independent risk factor.3.The ESBLs genes carried by ESBLs-producing Klebsiella pneumoniae is associated with genetic markers of MGEs.4.There is no outbreak of ESBLs-producing Klebsiella pneumoniae in hospital.