| Objective:1.To analyze the infection situation and risk factors of CRKP in comprehensive ICU from March to August 2019 in a certain area in Shanghai,and to establish a model of risk factors of CRKP infection in comprehensive ICU patients to provide a scientific basis for clinical effective monitoring and precise prevention and control of the infection and prevalence of CRKP in an area.2.To analyze the molecular epidemiological characteristics of CRKP isolated from all comprehensive ICUs in the March August 2019 region.Method:1.Using a retrospective study,the medical history data and ICU monitoring logs of patients in five comprehensive ICUs in a district of Shanghai from March to August2019 were collected,the information of patients with duplicate admissions was excluded,the data were analyzed using spss21.0 software,univariate analysis of the influencing factors of patients’infection CRKP was used,and then logistic regression analysis was combined to establish a risk factor prediction model of regional comprehensive ICU patients’infection CRKP.2.Collect the non duplicate CRKP isolated from the clinical specimens of patients admitted to 5 comprehensive ICUs in a district in Shanghai from March 2019 to August2019 to describe the specimen type,hospital distribution of strains and so on.All strains were subjected to the VITEK 2 compact fully automated microbial identification/susceptibility analyzer qualification review.The resistant phenotype of the CRKP strains was screened by phenotypic tests,the carbapenemase genes harbored by the CRKP strains(bla KPC、bla NDM、bla VIM、bla IMP、bla OXA-48、bla OXA-23and bla GES)were tested by PCR and the carbapenem resistant Enterobacteriaceae were screened,and the isolates that were positive by PCR amplification were sent to biologicals for sequencing.3.Seven housekeeping genes（gap A,infb,rpo B,mdh,Ton B,pgi and phoe）of K.pneumoniae were amplified by MLST and sequenced;PFGE was utilized to analyze the genetic characteristics of the strains.Result:1.2462 patients were admitted to the comprehensive ICUs of the 5 hospitals in the target area from March 2019 to August 2019.A total of 1460 patients were included in this study,of which 42 patients were infected with CRKP in the hospital,giving an infection rate of 2.9%.In univariate analysis,there were significant differences in the occurrence of CRKP infections between patients with different etiologies,such as age,ICU admission,number of days with indwelling central venous tube,number of days with gas cut cannula,number of days with indwelling urinary catheter,APACHE II score,use of antimicrobial agents,use of carbapenems,use of antimicrobial agents,and other infections（χ2=6.035,43.181,378.825,282.237,155.560,48.483,212.526,435.325,143.572,16.743,P<0.05）,and the results of binary logistic regression analysis showed that APACHE II score>15,indwelling central venous tube>7 days,having other infections,use of antimicrobial species>2,and use of carbapenem antibiotics were risk factors for the development of CRKP infection in patients in the comprehensive ICU of this region.CRKP infection risk prediction model regression equation=（APACHE II score>15）×2.464+（days in indwelling central venous tube>7）×2.817+other infections×4.690+（using antimicrobial drug species>2）×3.341+use of carbapenems×3.857。2.a total of 101 nosocomial K.pneumoniae isolates were isolated in March August2019,and a total of 50 CRKP isolates（eight of which were duplicate strains from different patients）were screened.Clinically isolated CRKP was mainly detected from sputum（71%,30/42）,urine（21%,9/42）,blood（5%,9/42）and others（2%,1/42）.The isolates showed high resistance to most antimicrobials,and the resistance rate to carbapenems and cephalosporins was up to 100%.Resistance phenotype screening resulted in 35 carbapenemase positive isolates,28 metalloenzyme positive isolates and16 extended spectrum isolatesβLactamase positive,of which 1 metalloenzyme positive strain coincided with a carbapenemase positive strain.The results of the amplification of resistance genes showed that 83.3%（35/42）were positive forbla KPC,14.3%（6/42）for bla OXA-23,2.4%（1/42）for bla NDM,and none were detected by bla VIM、bla IMP、bla OXA-48、bla GES.In addition,five isolates had both bla KPC and bla OXA-23 detected,and one had both bla KPC and bla NDMdetected.3.PFGE results the CRKP strains were divided into 12 types,including 12 strains in typeⅠ,which were mainly distributed in hospital C（7 strains）and hospital D（4strains）;There were seven isolates of type II,distributed in hospital B（four isolates）and hospital e（two isolates）;There were six strains of type III,three strains of each of types IV and V,all distributed in hospital B;There were 2 strains of type VI distributed in hospital a,2 strains of type VII,and 1 strain each in hospital B and hospital C;Type VIII had 2 strains distributed in hospital B;There are 2 strains of type IX,distributed in hospital C;1 strain for each of the remaining types（2 from hospital B and 1 from hospital C）;Demonstrated genetic diversity.MLST results showed that the predominant prevalent type in this region was ST11（28 strains）,followed by ST15（6 strains）,and several other strains were distributed sporadically,while new ST types were detected.Conclusion:1.Age,number of days in ICU,APACHEⅡscore,indwelling catheter,indwelling central venous tube,tracheal intubation,use of antibacterial drugs,use of carbapenem antibiotics,number of days of use of antibacterial drugs,infection with other drug-resistant bacteria,the patient is infected with CRKP Using Logistic regression analysis to fit these factors to the CRKP infection risk prediction model,so as to provide clinical application value for evaluating the risk prediction of CRKP infection in patients admitted to the comprehensive ICU.2.The detection rate of CRKP in comprehensive ICU patients in this area of Shanghai is relatively high.The main mechanism of drug resistance is carbapenemase production,which can carry a variety of drug resistance genes,of which the carbapenemase gene is mainly bla KPC.3.In the same hospital,carbapenem-resistant Klebsiella pneumoniae has an outbreak of the same clone,and there are also scattered types.The same ST type and PFGE type exist between different hospitals,which indicates that there may be clonal transmission between hospitals. |
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