Clinical Distribution,Drug Resistance Mechanism And MLST Analysis Of Carbapenems Resistant Klebsiella Pneumoniae

Objective: To study the clinical distribution,drug resistance mechanism and epidemiological analysis of carbapenem-resistant Klebsiella pneumoniae(CRKP)in our hospital,and to analyze the related risk factors of CRKP infection and death,and to provide a basis for clinical rational drug use.Methods:(1)Retrospective analysis of all CRKP strains in our hospital from 2017 to the first half of 2019.A total of 409 strains were removed from the same part of the same patient,and their specimen distribution and disease area distribution were analyzed.(2)According to clinical criteria for judging lung infection,urinary tract infection,and bloodstream infection,319 strains that finally met the standard were analyzed for independent risk factors for patient prognosis by Logistic regression.(3)Analysis of CRKP drug resistance and clinician medication and outcome of 319 patients.(4)Select 31 strains of CRKP isolated from the ICU from July 2018 to January 2019 for drug resistance mechanism and epidemiological analysis.Results:(1)Among the 409 CRKP strains,the specimens were mainly sputum,urine,blood,and secretions,and the composition ratios were 54.0%(221/409),30.1%(123/409),9.3%(38/409),and 5.4%.(22/409);CRKP isolated from sputum and urine showed a clear upward trend in the first half of 2017-2019,and the detection rate increased from 2.2%(7/316)to 31.0%(79/255),5.2 %(6/115)increased to 33.7%(32/95),and the differences were statistically significant(P <0.05).(2)The main departments are cadre health ward,ICU ward,neurology department,respiratory medicine department and neurosurgery department,the composition ratios are 30.8%(126/409),26.9%(110/409),12.2%(50/409),9.8 %(40/409),4.9%(20/409);From2017 to 2019,CRKP isolated from ICU ward,cadre health ward,neurology department,respiratory medicine department and neurosurgery showed a clear upward trend.18.4%(7/38)to 35.0%(14/40),0 to 42.5%(54/127),8.3%(2/24)to69.4%(25/36),and 0 to 35.7%(20/56)and 5.1%(4/78)increased to 25.0%(8/32),and the differences were statistically significant(P <0.05).(3)409 strains of CRKP were grouped.According to the clinical criteria of lung infection,urinary tract infection,and bloodstream infection,the risk factors for CRKP infection were included in 190 lung infection,97 urinary tract infection,and 32 bloodstream infection.analysis;Univariate and multivariate Logistic regression analysis showed that the independent risk factors for carbapenem-resistant Klebsiella pneumoniae lung infection among the relevant risk factors analyzed were age> = 65 years,gender(male),diabetes,Mechanical ventilation,use of penicillin antibiotics,cephalosporin antibiotics,aminoglycoside antibiotics,antifungal drugs,history of surgery;The independent risk factors for urinary tract infection were age> = 65 years,the use of broad-spectrum antibiotics and antifungal drugs before admission;the independent risk factors for bloodstream infection were the use of antifungal drugs.(4)The average drug resistance rate of CRKP to compound neonomine is 82.4%,and the average drug resistance rate of the remaining 17 antibacterial drugs exceeds 90%.The resistance rate of CRKP to cefepime has declined from 2017 to 2019.The drug resistance rates of micarcin,gentamicin,tobramycin,compound sinomine and furantoin increased.(5)The study found that the mortality rate of unadjusted patients in the cadre health ward(64.8%)was significantly higher than that of adjusted medication patients(20.4%),and the difference was statistically significant(P <0.05);the remaining departments(ICU ward,respiratory(Intensive care,intensive care and nephrology,etc.)The mortality rate of patients with unadjusted medication was higher than that of patients with adjusted medication,but no significant difference was found.(6)Analysis of drug resistance mechanism showed that carbapenemase was produced by ?: 28 strains only expressed KPC-2 carbapenemase gene,1 strain only expressed NDM-1 carbapenemase gene,and 2 strains expressed simultaneously KPC-2 and NDM-1 carbapenemase genes,but 31 strains of CRKP did not express IMP,VIM,IMI,SPM,OXA-48,GES,SME,SIM,GIM carbapenemase genes.? External pump overexpression: None of the 31 strains were overexpressed,indicating that the drug resistance mechanism was not caused by efflux pump overexpression.(3)Outer membrane proteins were deleted.Among 31 strains,KP4 strains had Omp K 36 deletions,and the rest had no protein deletions.(7)Multi-site sequence typing(MLST):29 strains were of type ST11,1 strain was of type ST4477,and 1 strain was of new ST type.Conclusion: CRKP is mainly from sputum,urine and blood samples,which are mainly distributed in the cadre health care wards and ICU with severe illness and long hospitalization.The detection rate of CRKP keeps increasing,presenting multiple drug resistance.According to the independent risk factor analysis of CRKP infection,reasonable treatment schemes should be selected according to the patient's condition in the clinical treatment.KPC enzyme was the main resistance mechanism of CRKP in our hospital ICU,followed by the absence of outer membrane protein Omp K 36.The main resistance gene carried by CRKP in our hospital was blakpc-2,followed by blandm-1,and the ST type was mainly ST11.