Analysis Of Characteritics And Risk Factors Of Carbapenem-resistant Enterobacteriaceae Infection

Part one Detection resistance genes and homology analysis ofCarbapenem-resistant EnterobacteriaceaeObjective:To retrospectively analyze the resistance rate and homology of Carbapenem-resistant Enterobacteriaceae(CRE)in order to investigate the presence of nosocomial infection.Methods:1 The resistance rate of Enterobacteriaceae to carbapenem antibiotics in hospitals from 2012 to 2017 was analyzed by using WHONET5.6 software in order to know the changing trend of resistance rate.2 Pulse field gel electrophoresis(PFGE)and homology analysis were performed on some strains of Carbapenem-resistant Enterobacteriaceae(CRE)isolated from January 2014 to August 2017.Results:1.In 2014,the resistance rates of Enterobacteriaceae to imipenem and meropenem were 1.1% and 1.0%,respectively.In 2015 the resistance rates to imipenem and meropenem were 4.1% and 3.4%.The resistance rate to imipenem and meropenem increased to 7% and 6.7% in 2016.The resistance rates decreased to 4.1% and 3.4% in 2017.2.The results of homology analysis showed that the main epidemic strains of Klebsiella pneumoniae appeared from June 2015 to July 2016,and the correlation was strong.The Dice coefficient of all strains of Escherichia coli was less than 90%,and the correlation was relatively low.Part two Analysis of R isk factors for Carbapenem-resistantEnterobacteriaceaeObjective:In order to know the risk factors related to the infection of CRE,to grasp the population characteristics,to strengthen the preventive measures of the corresponding departments and important population and to reduce the incidence of nosocomial infection finally.Methods:In order to analyze the risk factors of the infection of CRE,a multivariate regression model was established by retrospective analysis of the clinical material such as the basic condition of patients,hospitalization,treatment measures and antibiotics.Results:Univariate and multivariate logistic regression analysis showed that the risk factors for infection of carbapenem resistant Enterobacteriaceae were transferred to hospital(OR=6.043),hospitalized more than 2 times(OR=4.104),admitted to ICU(OR= 14.368),and carried other multidrug resistant bacteria(OR=4.536);and used Aminoglycosides(OR=2.998).Part three Application value of procalcitonin in EnterobacteriaceaeinfectionObjective:To understand the infection characteristics of Enterobacteriaceae and to explore the clinical application value of procalcitonin.Methods:Using rank sum test and ROC curve analysis,the level of procalcitonin in patients infected by Enterobacteriaceae bacteria was analyzed.Results:Procalcitonin could be used to distinguish the bloodstream infection caused by Enterobacteriaceae from non-bloodstream infection.In non-bloodstream infection group the procalcitonin of CRE was slightly higher than that in CSE group.There was no significant difference in the level of procalcitonin between CRE and CSE group in bloodstream infection.Conclusion:1.From 2015 to the 2016,some strains of carbapenem-resistant Enterobacteriaceae had strong homology,but the time span was longer,and whether there existed nosocomial infection should be combined with epidemiological investigation.2.Transfer to hospital,hospitalization more than 2 times,admission to ICU,use of other multidrug resistant bacteria as risk factors for infection of carbapenem-resistant Enterobacteriaceae bacteria.3.Procalcitonin can be used in the identification of bloodstream and local infection caused by Enterobacteriaceae.It is helpful to discriminate bloodstream infection bacterial species and to know the infection status of patients in clinic.