| Objective 1.To understand the clinical distribution characteristics of carbapenem-resistant Klebsiella pneumoniae infection among inpatients in Fuyang People’s Hospital and their resistance to common clinical antibiotics;2.Risk factors of infection with carbapenem-resistant Klebsiella pneumoniae were analyzed;3.Molecular epidemiological characteristics of Klebsiella pneumoniae resistant to carbapenems were analyzed;4.Screening carbapenems and carbapenems genes carried by Klebsiella pneumoniae.5.To provide theoretical guidance and scientific basis for the prevention,control and treatment of carbapenem-resistant Klebsiella pneumoniae.Methods 1.General clinical data of patients with carbapene-resistant Klebsiella pneumoniae strains and patients in Fuyang People’s Hospital of Anhui from January 2018 to June 2019 were collected,and hospitalized patients infected with carbapene-sensitive Klebsiella pneumoniae during the same period were selected as controls;2.The pathogen status of the patients was determined with the automatic bacterial identification instrument Meriek 2 Compact.To ensure the identification results of the screened strains were correct,the stroma-assisted laser desorption ionization time-of-flight mass spectrometry(MALDI-TOF-MS)was used for the second review;3.Drug sensitivity experiment was conducted with VITEK 2 Compact automatic microbial identification analyzer and GN identification card;4.Homology analysis of drug-resistant bacteria was conducted;5.The modified carbapenem inactivation test(m CIM)and Carba NP test were used to screen the carbapenems carried by klebsiella pneumoniae strain;6.Colloidal gold immunochromatography was used to screen carbapenem carried by bacteria;7.The carbapenems genes bla KPC,bla NDM,bla VIM,bla IMP and BLaoxa-48 were detected by PCR;8.SPSS 23.0 software was used for processing,in which the counting data were expressed as(%)and X2 test was performed to analyze the single factor of infection with carbapenem-resistant Klebsiella pneumoniae,and the multiple factors of infection with carbapenem-resistant Klebsiella pneumoniae were analyzed by Logistic regression.P<0.05 was statistically significant.Results 1.The 86 strains of Carbapenem-resistant Klebsiella pneumoniae were selected,mainly from intensive care unit(ICU),respiratory and critical care medicine department and general surgery department.The samples were mainly sputum specimens,followed by whole blood and urine;2.86 strains of CRKP showed multiple drug resistance.Among them,cefuroxime,ceftriaxone,cefoperazone/sulbactam,piperacillin/tazobactam were all 100% resistant.The drug resistance rates of imipenem,Meropenem and ertapenem were 100%,98.84% and 100% respectively.CRKP is 100% sensitive to tigacycline;3.The homology analysis: 86 strains CRKP can be divided into A,B,C,D,E and F type,A type of 47 strains for most,14 strains type B,type C 16 strains of type D 6 strains,E,F type 2 strains,1 strain type A(25 strains)are mainly distributed in the ICU,respiratory critical care medicine ICU(12 strains),general surgery(4 cases),and the rest of the type B,C,D,E and F each model is send out status,distribution in various clinical departments;4.Mechanical ventilation and the use of 3 or more antimicrobial agents were risk factors for infection with carbapenems resistant Klebsiella pneumoniae;5.MCIM test and Carba NP test had 93.02% and 91.86% positive rates for bacterial carbapenem screening,respectively.6.Colloid immune chromatography to detect penicillium carbon olefine enzymes: according to the results of the 86 strains CRKP,76 strains,positive negative 10 strains(negative sample number: 21,30,37,43,47,49,50,66,77,81),the positive rate of 88.37%,the detected KPC type carbon alkene enzyme 73 strains,NDM type carbon alkene enzyme 3 strains,OXA-48,VIM,IMP type carbon penicillium enzyme has not been checked out;7.PCR genotyping: Among the 86 STRAINS of CRKP,the carbapenase gene was detected in 76 strains,and the positive rate was 88.37% in 10 strains(negative sample Numbers: 21,30,37,43,47,49,50,66,77,81).Among them,73 strains containing bla KPC-2 gene and 3 strains containing bla NDM-1 group genes were detected,while the drug-resistant genes bla VIM,bla IMP and BLAOXa-48 were not detected.Conclusion 1.The sources of carbapene-resistant klebsiella pneumoniae in Fuyang People’s Hospital are mainly intensive care unit(ICU),respiratory critical care medicine department and general surgery department.Drug-resistant bacteria are widely distributed and need strict prevention and control;2.The sputum samples had the highest isolation rate of carbapenems klebsiella pneumoniae,followed by whole blood and urine.Respiratory system is susceptible to carbapenem-resistant klebsiella pneumoniae,and urinary system and blood flow resistant carbapenem-resistant klebsiella pneumoniae infection cannot be ignored;3.The isolated CRKP is characterized by multi-drug resistance,highly resistant to common clinical antibacterial drugs,and highly sensitive to only tiacycline.The drug resistance of CRKP should be closely monitored;4.The main clones of CRKP are concentrated in ICU and respiratory critical care medicine,which should be paid attention to,and corresponding defense and intervention measures should be taken;5.Mechanical ventilation and the application of 3 or more antimicrobial agents are the risk factors for infection with carbapenems klebsiella pneumoniae,so the diagnosis and treatment should pay more attention to the risk factor;6.Carba NP test and m CIM test have similar detection rates for carbapenems carried by CRKP,and m CIM is easier to operate and has shorter operation time.MCIM is more suitable for clinical application than Carba NP in the detection of CARBapenems of CRKP.7.The detection rate of carbapenems by colloidal immunochromatography was 100% consistent with that of PCR.As colloid immunochromatography has advantages of simple operation,short detection time and low cost,it is recommended for clinical application;8.The carbapenase genes of CRKP isolated in our hospital were mainly bla KPC-2 and bla NDM-1,and the distribution of carbapenase genes was relatively single,so the prevalence of bla NDM genotypes should be concerned. |
