Detection and clinical analysis of carbapenemase gene of carbapenem-resistant Enterobacterales
Objective To observe the clinical distribution,drug resistance and carbapenem-resistant genes and clinical situation of carbapenem-resistant Enterobacterales(CRE)in the hospital.Methods A total of 128 non-duplicate CRE strains were isolated from clinical samples,which were identified and rechecked using VITEK 2 Compact and matrix-as-sisted laser desorption/ionization time-of-flight mass spectrometry.All the strains were analyzed with carbapenemase phen-otypic screening test(mCIM and eCIM),the enzyme type were detected using the rapid detection method of car-bapenemase(colloidal gold immunochromatography)and PCR was used to detect the genotype.WHONET 5.6 was used to analyze the clinical distribution and drug resistance.Review the patient case data for CRE strains.Results A total of 82 strains were mCIM positive and eCIM negative;22 strains were mCIM positive and eCIM positive;24 strains were mCIM negative and eCIM uninterpreted.The results of immunochromatography and PCR detection were 82 KPC-producing strains(78.8％),21 NDM-producing strains(20.2％),and 1 IMP-producing strain(1.0％).;no VIM and OXA resistance genes were detected.Klebsiella pneumoniae mainly carried KPC(92.8％),and Escherichia coli mainly carried NDM(91.7％).Klebsiella pneumoniae accounted for the highest proportion of CRE strains(72.7％),followed by Escherichia coli(16.4％);CRE mainly distributed in neurosurgery(27.3％),followed by ICU(23.4％).Sputum samples were the main type(66.4％),followed by urine samples(16.4％).The resistance rate to Ertapenem,Imipenem and Meropenem were 100.0％,83.6％and 80.5％respectively,and that to Ceftazidime/Avibactam was 17.2％.The drug-resistant strains were found in NDM-and IMP-producing strains respectively,but the resistance rate to Tigecycline was lower(2.5％).There were 70 males and 51 females,mainly elderly patients,53.7％of whom were over 60 years old.The main underlying diseases were craniocerebral diseases,followed by malignant tumors and type 2 diabetes mellitus.88.4％of the patients used two or more kinds of antibiotics;duration of hospitalization＞14 days accounted for 76.9％,use of antibiotics＞14 days accounted for 70.2％;death and/or voluntary discharge accounted for 39.7％.Conclusion CRE strains mainly carry KPC resistance genes,and most of them are distributed in the neurosurgery department,with Klebsiella pneumoniae accounting for the highest proportion,mainly in sputum specimens.CRE infection is mainly found in elderly patients with craniocerebral dis-eases,long hospital stay and use of multiple antibiotics.These results have important reference value for strengthening clin-ical drug resistance monitoring and rational selection of antibiotics.
万方数据
维普
