Molecular Characteristics, Drug Resistance Monitoring And Clinical Risk Factors Analysis Of Carbapenem-Resistant Enterobacteriaceae Bacteria

Objective: To guide the rational use of antibiotics in clinic by analyzing the drug resistance monitoring results of CRE.Through comparative analysis of mortality,hospitalization days and treatment costs of patients with bloodstream infection CRKP and non-CRKP,the harm and severity of patients with CRKP infection are suggested,and the laboratory can timely and accurately detect CRKP and reduce nosocomial infection.Through the univariate and multivariate analysis of KP induced death and CRKP induced by bloodstream infection,the theoretical basis for reducing the mortality of KP infection and the incidence of CRKP infection was provided.Through the analysis of CRE resistance genes,we can understand the types of CRE prevalent genes in this region,and provide scientific basis for the traceability and tracing of nosocomial infection CRE.Methods:(1)A total of 681 STRAINS of CRE isolated from our hospital from January 2014 to December 2020 were analyzed in terms of specimen source,disease area source,detection rate and drug resistance rate.(2)The mortality,length of stay and treatment cost of 112 patients with bloodstream infection klebsiella pneumoniae in our hospital from January2018 to July 2021 were compared and analyzed between CRKP group and non-CRKP group.Univariate and multivariate analysis of 112 cases of KP induced death from bloodstream infection;The correlation factors of 28 cases of CRKP bloodstream infection were analyzed.(3)A total of 30 STRAINS of CRE isolated from November 2020 to May 2021(16 strains of CRKP,7 strains of CRECL and 7 strains of CRECO,respectively)were tested for drug resistance genes.Results: A total of 681 STRAINS of CREKP were detected from 2014 to2020,mainly CRKP,CRECL and CRECO,with composition ratios of81.94%,7.20% and 6.46%,respectively.The average detection rates of CRKP,CRECL and CRECO were 12.71%,4.37% and 0.36%,respectively.CRKP and CRECL were mainly sputum and urine,while CREC was mainly urine.The health care centers of cadres from the ward all ranked first.The detection rate of CRKP was relatively flat from 2014 to2016,and showed an upward trend after 2017,especially in 2018,followed by a downward trend.The comparison of detection rates from 2014 to 2020 showed statistically significant difference(P<0.05).The detection rate of CRECO was relatively flat from 2014 to 2017,and the detection rate of CRECO showed an upward trend in 2018,which was most obvious in 2019,followed by a downward trend.The difference was statistically significant between 2014 and 2020(P<0.05).There was no regular change in CRECL detection rate from 2014 to 2020,and the difference was not statistically significant(P>0.05).From 2014 to 2020,the drug resistance rates of CRKP to piperacillin,amtronam,tobramycin and cotrimoxazole showed an overall downward trend,with statistically significant differences(P<0.05).The drug resistance rates to ceftriaxone,cefotetan,melopenem,amikacin,gentamicin,ciprofloxacin,levofloxacin and furantoin showed an increasing trend,and the difference was statistically significant(P<0.05).Among 112 patients with bloodstream infection KP,the mortality rate of CRKP group(67.86%)was higher than that of non-CRKP group(15.48%),and the difference was statistically significant(P<0.05).The median length of hospital stay in the CRKP group(27.5 days)was higher than that in the non-CRKP group(14 days),and the difference was statistically significant(P<0.05).The median treatment cost in the CRKP group(117312.5 yuan)was higher than that in the non-CRKP group(18910.5 yuan),and the difference was statistically significant(P<0.01).KP,112 cases of bloodstream infection induced by the single factor and multiple factors analysis of death,anemia,renal insufficiency,heart disease,respiratory failure,abnormal platelet,venous catheter,endotracheal intubation,urethral catheter,surgery,whether for CRKP and using hormonal penicillium,three or more antibiotics,carbon alkene,antifungal drugs and KP associated bloodstream infection induced death;Surgical history and CRKP were independent risk factors for death induced by KP bloodstream infection.Univariate and multivariate analysis of 28 cases of CRKP bloodstream infection showed that anemia,abnormal liver function,heart disease,respiratory failure,intravenous catheter,endotracheal intubation,indwells catheter,gastric tube,use of hormones,carbapenems,antifungal drugs and more than three antibiotics were all associated with CRKP bloodstream infection.Abnormal liver function and use of antifungal drugs were independent risk factors for bloodstream infection of CRKP.Carbapenemase factor detection results of 30 CRE strains(16 STRAINS of CRKP,7 strains of CRECL and 7 strains of CRECO)showed that 14 strains of KPC-producing gene(all CRKP strains)and 14 strains of NDM gene(2strains of CRKP,5 strains of CRECL and 7 strains of CRECO).Two strains(all CRECL strains)did not express any KPC,NDM,IMP,VIM and OXA carbapenase genes.Conclusion: CRKP,CRECL and CRECO are the most common CRE,and the isolation rate and drug resistance rate are higher.The mortality,hospital stay and treatment cost of bloodstream infection CRKP patients were significantly higher than those of non-CRKP patients.Surgical history and CRKP were independent risk factors for death induced by KP bloodstream infection,while abnormal liver function and use of antifungal drugs were independent risk factors for CRKP bloodstream infection.In our hospital,THE main CRE genotypes were KPC and NDM,among which THE main genotypes of CRKP were KPC,and the main genotypes of CRECL and CRECO were NDM.The hospital should strengthen the monitoring and detection of CRE bacteria,use antibacterial drugs scientifically and rationally,and reduce the infection of CRE in hospital.