| Objectives:To investigate the risk factors and prognostic factors of carbapene-resistant pseudomonas aeruginosa(CRPA)infection.Carbapenem enzyme assay and drug sensitivity analysis were performed on imipenem resistant pseudomonas aeruginosa(IRPA),and molecular epidemiological study was conducted to provide a basis for the control of hospital IRPA infection.Methods:1.Case-control study was adopted.Electronic case data of 45 patients with CRPA infection in the first affiliated hospital of nanchang university from January2017 to October 2017 were selected,and 33 patients infected with CSPA(carbapenesensitive pseudomonas aeruginosa)during the same period were selected as the control group.2.Age,mechanical ventilation time,combined basic diseases,time spent in intensive care unit,application time of immunosuppressive agents,and empirical use of carbapenems antimicrobial agents were recorded in the two groups.Single factor and multi-factor conditional logistics regression was used to analyze risk factors.3.80 strains of IRPA(imipenem-resistant pseudomonas aeruginosa)isolated clinically in 2017 were collected.Phenotype detection of IRPA strains was performed using the modified carbapenem inactivation test(mCIM method)and the modified Hodge method.4.The differences of drug resistance spectra between IRPA strains producing carbapenem and IRPA strains producing no carbapenem were compared and analyzed,and the drug resistance and molecular epidemiological characteristics of strains carrying different types of carbapenem were analyzed.Results:1.Surgery,invasive procedures,aminoglycosides,and blood type were independent risk factors for CRPA infection.2.A total of 32(40%)mCIM phenotypes were positive in 80 IRPA strains,whileonly 15(18.75%)were positive in the modified Hodge test.PCR showed 12 VIM positive strains(15%)and 18 KPCpositive strains(22.5%).Two strains of NDM(2.5%)were detected,and no other carbapenems genes,such as OXA-48,were detected.3.The drug resistance rates of carbapenem producing IRPA strains against ceftazidime,cefepime,piperacillin / tazobactam,cefoperazone / sulbactam,and amikacin were 87.5%,87.5%,68.75%,68.75%,and 68.75%,respectively,which were significantly higher than those of non-carbapenem producing IRPA strains(37.5%,35.42%,22.92%,22.92%,and 35.42%),and the differences were statistically significant(P<0.05).4.MLST and PFGE genotyping showed that IRPA strains were divided into12 genotypes,mainly ST235/A,ST244/D and ST639/K,among which the enzymeproducing IRPA strains were mainly prevalent in ST235/A,ST235/G,ST244/D,ST639/K and ST1029/G.Conclusion:1.The situation of CRPA infection was severe with poor prognosis.Rational use of antimicrobial agents and reduction of unnecessary invasive diagnosis and treatment were measures to reduce the infection and improve the efficacy.2.IRPA strains isolated in this region were mainly produced VIM and KPC,which were highly resistant to a variety of commonly used clinical antimicrobial agents.Detection and monitoring of enzyme-producing strains should be strengthened to prevent the spread and epidemic of drug resistance. |
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