Clinical Characteristics And Molecular Epidemiology Of 70 Strains Of Carbapenem-Resistant Klebsiella Pneumoniae

Objective:Clinical characteristics of carbapenem-resistant Klebsiella pneumoniae isolated from clinical samples were collected.Drug resistance genes of the strain were investigated and drug sensitivity was analyzed to provide evidence-based medical basis for clinical rational drug use and prevention and control of nosocomial infection.Method:(1)The clinical isolates of Klebsiella pneumoniae from the Affiliated Hospital of North Sichuan Medical College from November 2020 to November 2021 were collected;(2)The pathogen was identified by mass spectrometry;(3)The drug sensitivity experiment of pathogenic bacteria was carried out by VITEK 2 compact automatic identification/drug sensitivity analysis system;(4)Clinical data including gender,age,department,separation site,underlying diseases,antibiotic treatment,pioneering operation and prognosis of the infected patients were collected;(5)Carbapenem inactivation method(mCIM)combined with EDTA carbapenem inactivation test(eCIM)was used to detect carbapenem in CRKP;(6)The carbapenem resistance genes KPC,NDM,VIM,IMP and OXA-48 were detected by polymerase chain reaction(PCR).Results:(1)70 strains of carbapenem-resistant Klebsiella pneumoniae were collected from the Affiliated Hospital of North Sichuan Medical College;From 9 different departments,the main source department is the Intensive Care Unit(ICU),27 strains(38.57%);Followed by Neurosurgery,13 strains(18.57%);Respiratory medicine,8 strains(11.43%).The main source of specimens was sputum,34 strains(48.57%);Followed by blood,16 strains(22.86%);Urine,10 strains(14.29%);(2)70 strains of carbapenem-resistant Klebsiella pneumoniae showed high resistance to most antibiotics such as penicillins,quinolones and cephalosporins.The sensitivity of CRKP to cotrimoxazole was 10.00%,to amikacin was 14.29%,to doxycycline was 15.71%,and to tegacyclin and myxin was 100.00%;(3)Carbapenem inactivation method(mCIM)and EDTA carbapenem inactivation test(eCIM)were used to detect the carbapenem phenotype of CRKP;63 strains were positive for mCIM and 9 strains were positive for eCIM.(4)PCR genotyping:63 of 70 CRKP strains were detected to carry carbapenem gene,with a positive rate of 90.00%,including 54 strains(85.71%)carrying KPC gene and 15 strains(23.80%)carrying NDM gene.Six strains(9.52%)carried two drug resistance genes at the same time.No drug-resistant strains carrying blaVIM,blaIMP and blaOXA-48 were detected.Conclusion:(1)70 strains of carbapenem-resistant Klebsiella pneumoniae showed high resistance to most antibiotics such as penicillins,quinolones and cephalosporins.CRKP has good sensitivity to tegacyclin and myxin.It is speculated that they can be used as one of the empirical treatment options of CRKP;(2)Carbapenem inactivation method(mCIM)and EDTA carbapenem inactivation test(eCIM)are simple and operable methods for the detection of carbapenem;(3)The carbapenemase genes mainly carried by CRKP isolated in our hospital are KPC and NDM.The prevalence of drug resistance gene NDM should be paid attention to.