| Objective In order to investigate the distribution and drug resistance of carbapenem-resistant klebsiella pneumoniae(CRKP),carbapenem-resistant pseudomonas aeruginosa(CRPA)and carbapenem-resistant acinetobacterbaumannii(CRAB)in two different hospitals in Shanghai and Hunan from 2017 to 2019.Method Using hospital information system(HIS),retrospective analysis was performed on the data from a second-grade hospital in Shanghai and a third-grade hospital in Hunan province from January 2017 to December 2019.and compared the detection of CRKP,CRPA and CRAB in the two hospitals in four aspects,including specimen source,drug resistance rate,department distribution,and defined daily dose(DDD).PCR was used to amplify the genes of CRKP: carbapenemase genes(bla KPC,bla IMP,bla VIM,bla SIM-1,bla SPM,bla GIM,bla NDM-1),OXA gene(bla OXA-48),ESBLs(blaCTX-M-1-group,BlaCTX-M-9-group,blaCTX-M-2-group,blaCTX-M-8-group,bla SHV and bla TEM),combined with agarose gel electrophoresis and Multilocus sequence typing to understand the distribution of resistance genes and homology of them.Using PCR to amplify the isolated carbapenemase-related genes of CRPA(bla OXA,bla IMP,bla VIM,bla SPM,bla TEM,bla PER,bla GES and bla SHV),then understanding the distribution of resistance genes through agarose gel electrophoresis.PCR was used to amplify the isolated carbapenemase-related genes and integrons of CRAB(bla OXA-51,bla OXA-23,bla OXA-24,bla OXA-58,bla OXA-143,bla OXA-235,bla IMP,bla VIM,IntⅠand Int Ⅱ),agarose gel electrophoresis was used to understand the distribution of drug resistance genes and the results of drug sensitivity.Finally,SPSS 21.0 and Excel were used for statistical data analysis.Results From 2017 to 2019,CRKP were detected from different sources between the two hospitals(X2 = 7.1368,P = 0.0076).The clinical distribution of the Shanghai second-class hospital was mainly in urine,and the Hunan third-class hospital was mainly in sputum.The sources of CRPA from 2017 to 2019 were different(X2 = 1.1006,P = 0.2958).After pairwise comparison,the proportions of sputum,urine and blood were different.In 2017-2019,the sources of CRAB were different(X2 = 30.8280,P < 0.0001).After pairwise comparison,the proportions of sputum and urine were different.In the two hospitals,CRKP had the highest drug resistance rate to cefuroxime,the lowest drug resistance rate to minocycline and colistin.CRPA had the lowest drug resistance rate to amikacin.CRAB had a higher resistance rate to ticarcillin and the lowest resistance rate to minocycline.Comparing the distribution of the departments of the two hospitals in 2019 for carbapenem-resistant CRKP,CRPA and CRAB,most of them came from the Department of Neurosurgery,Critical Care Medicine,and Emergency Medicine.There was no statistical difference in the sources of departments(P>0.05).It can be found that the neurosurgery,critical care medicine,and respiratory medicine emergency medicine departments have the highest consumption of meropenem by comparing the DDD in the two hospitals.From the data of the two hospitals in terms of drug resistance,the value of a third-class hospital in Hunan Province is lower than that of a second-class hospital in Shanghai(P<0.05).The results of the 36 strains of carbapenem-resistant CRKP-related genes amplified by PCR to judge the drug-resistant genes in a second-class hospital in Shanghai showed that bla KPC positive rate was 84.21%,bla VIM positive rate was 78.95%,bla SIM-1 positive rate was 73.68%,bla GIM positive rate was 57.89%,bla OXA-48 positive rate was 100%,CTX-M-9-group positive rate was 78.95%,bla SHV positive rate was 63.16%,and bla TEM positive rate was 47.37%.The drug resistance genes in a third-class hospital in Hunan Province illustrated that bla KPC positive rate was 94.12%,bla VIM positive rate was 100%,bla SIM-1 positive rate was 100%,bla GIM positive rate was 70.59%,CTX-M-9-group positive rate was 47.06%,the positive rate of bla SHV was 100%,and the positive rate of bla TEM was 76.47%.No bla OXA-48、CTX-M-2-group was detected in either hospital.MLST was used to type ST11 and ST15,which are the most popular virus genes in a second-A hospital in Shanghai,and it was found that the number of ST11 was 18 and ST15 was 1.There are mainly ST11,ST571,ST660,ST2237 and ST1074 virus strains in a third-class hospital in Hunan Province,among which there are 2 ST571,12 ST11,and one ST strain each.The carbapenem-resistant CRPA-related genes collected by PCR with 31 samples which detected the drug resistance genes in a second-class hospital in Shanghai showed positive rate of OXA was 43.48% and positive rate of TEM was 100 %.The positive rate of SHV was 65.22%.The drug resistance genes detected in a third-class hospital in Hunan Province showed positive rate of OXA was 62.50%,positive rate of TEM was 100%,positive rate of SHV 100%.No IMP,SPM and GES were detected in either hospital.The 57 carbapenem-resistant CRAB-related genes collected by PCR detected in a second-class hospital in Shanghai showed positive rate of OXA-51,OXA-23,OXA-235,IMP,VIM,Int Ⅰand Int Ⅱ was 84%,28%,32%,76%,56%,100% and 44%.The drug resistance genes detected in a third-class hospital in Hunan Province depicted positive rate of OXA-51,OXA-23,OXA-235,IMP,VIM,Int Ⅰ was 93.75%,53.13%,15.63%,78.13%,21.88%,100%.OXA-24 and OXA-143 were not detected in the two hospitals.[Conclusion](1)From 2017 to 2019,CRKP were detected from different sources in the two hospitals.The clinical distribution of a second-class hospital in Shanghai was mainly urine,and the clinical distribution of a third-class hospital in Hunan was mainly sputum.The sources of CRPA are same sources,and both hospitals use sputum as the main source.The specimens of CRAB are of same sources,and both hospitals mainly use sputum.The data source is consistent with the national drug-resistant bacteria surveillance network.(2)Department sources of carbapenem-resistant CRKP,CRAP and CRAB in the two hospitals in 2019,Most of them came from the department of neurosurgery,critical care medicine,and emergency medicine.It is recommended that the above clinical departments should select antibacterial drugs based on drug susceptibility tests to slow down the production of resistant bacteria.(3)The resistance mechanism of CRKP in the two hospitals were mainly related to the bla KPC,bla VIM,The antimicrobial resistance mechanism of carbapenem-resistant CRAP were mainly related to the resistance genes named OXA,TEM,and SHV.The antimicrobial resistance mechanism of carbapenem-resistant CRAB in two hospitals were mainly related to the OXA-51,OXA-23,but the second-class hospital in Shanghai was also related to Int Ⅱ. |
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