The Molecular Epidemiology Of Bloodstream Infections Klebsiella Pneumoniae And The Sruvey For Risk Factors Of Resistance To Carbapenems Antimicrobial

Objective:The aim of this study is to investigate the molecular epidemiology of Klebsiellapneumoniae that separated from blood, determine the main genotype of the Klebsiellapneumoniae.;Discus the main risk factors of the blood infection that the Klebsiellapneumoniae isolates were resistant to carbapenem.Investigate the resistancemechanisms,transmission mechanisms of Klebsiella pneumoniae separated fromblood.Methods:1、120Klebsiella pneumoniae isolates were collected from inpatients in March2012to September2013that separated from blood isolates. The antimicrobialsusceptibility was determined by minimal inhibitory concentration. Compare ESBLspositive and negative Klebsiella pneumoniae department distribution, multi-drugresistant Klebsiella pneumoniae and non-multidrug-resistant Klebsiella pneumoniaedepartment distribution.2、The main genotype was determined by Eric-PCR and Multiple LocusSequence Typing. Analysis mainstream genotypes of Klebsiella pneumoniae isolatedand the distribution of and their departments.3、The KPC、IMP、 VIM、 NDM-1、int、CS、acc6-Ib、qnrS、 qnrA、qnrB were detected by Polymerase Chain Reaction, the positive samples’genotypewere confirmed by DNA sequencing.4、The restrospective survey was used to investigate risk factors that theKlebsiella pneumoniae isolates separated from blood were resistant to carbapenem.The clinical data of patients in hospital that blood infection was collected from June2009to December2012and Univariate analysis and multiple logistic regressionanalysis were used.Results:1、The resistance patterns of Klebsiella pneumoniae include: resistance to carbapenems, producing extended-spectrum β-lactamase and multi-drug resistancepatterns.2、34Klebsiella pneumoniae were ST395,is the main genotype. Mainly in theburn unit, hematology, gastroenterology, neurosurgery, intensive medicine.Andpresents colning spread trends.3、86Klebsiella pneumoniae mainly carrying carbapenemase genes,aminoglycoside modifying enzyme gene and gene-based quinolones, while detectinga Klebsiella pneumoniae carrying NDM-1gene.The Aminoglycosides andfluoroquinolones engaging gene present in plasmid together with theplasmid-mediated transmission.4、 Multivariate logistic regression analysis showed catheterization,bloodtype(A-type),the use of aminoglycoside antibiotics and anti-fungal bloodstreaminfection were independent risk factors for Klebsiella pneumoniae that resistant tocarbapenem antibiotics.Conclusion：ST395is the main genotype of Klebsiella pneumoniae separated from blood, andthe resistance is serious.We detected multiple resistance gene, the resistance genecould spreaded by colning and plasmid. We should pay special attention to theclinical work: urinary catheter; rational use of aminoglycoside antibiotic andanti-fungal drugs.