Study On Drug Resistance Of Enterobacter And Klebsiella In Our Hospital

Objectives:The detection rates of Enterobacter and Klebsiella in our hospital are increasing year by year,producing Extended-spectrum ?-lactamase(ESBLs)is the main cause of drug resistance of strains nowadays.They showed varying degrees of resistance for antimicrobial agents,and the bacterial resistance was on the rise,so it brought a lot of difficulties to treat bacterial infections.So as to provide a basis for clinical anti-infective treatment and reasonable chioce of antibiotics,we investigate the drug resistance,clinical distribution and infection trend of Enterobacter and Klebsiella in our hospital,moreover,the production of drug resistant strains would reduced,and saving medical resources.In addition,it also can provide theoretical data and other support for epidemiological investigation.Methods :1.Samples selection: All Enterobacter and Klebsiella bacteria were detected in Chengde Central Hospital from 2015 to 2018,including sputum,urine,blood,secretions,bile,etc.And remove the same strain from the same patient and the same part.2.Test methods:The identification and antibiotic susceptibility tests were conducted by VITEK-2 Compact Automatic Microbial Identification Analyzer and the drug susceptibility paper method(K-B method)recommended by the American Association for Clinical and Laboratory Standardization(CLSI).3.Data result analysis:whonet5.6 software was used to analyze the variation of drug resistance of every year?distribution and origin of specimens,etc.Results:1.A total of 1047 Klebsiella pneumoniae strains detected in our hospital from 2015 to 2018,and they were mainly Klebsiella pneumoniae,92%(963 plants),a total of 251 strains of Klebsiella that producing ESBLs were detected.A total of 184 strains of the genus Enterobacter were detected from 2015 to 2018,most of them were Enterobacter cloacae(72%)and Enterobacter aerogenes(25%),among them,70 strains of enterobacterium that producing ESBLs were detected.In addition,the number of Carbapenem-Resistant Enterobacter also increased in our hospital.2.The specimens of Enterobacter and Klebsiella were mainly detected from sputum,urine,blood,secretions and other types of specimens.3.Klebsiella is mainly distributed in neurosurgery(19.0%),critical medicine(14.4%),respiratory medicine(11.0%),geriatrics(10.5%),neurology(8.2%),etc,and the strains of Klebsiella producing ESBLs were mainly distributed in neurosurgery(34.2%),severe medicine(31.0%),urology(11.6%),respiratory medicine(6.8%)and geriatrics(3.6%).Enterobacter strains were mainly distributed in neurosurgery(18.0%),severe medicine(12.6%),urology(12.0%),geriatrics(11.4%)and general surgery(7.2%),and the strains of Enterobacter producing ESBLs were mainly distributed in neurosurgery(20.0%),urology(15.7%),critical medicine(12.8%)/ geriatrics(8.5%).4.Enterobacter and Klebsiella that producing extended spectrum beta-lactamases(ESBLs)have the highest drug resistance rates to penicillins(such as piperacillin,teicacillin),cephalosporins(such as cefuroxime,cefoperazone,ceftriaxone,cefotaxime,et al.)In our hospital,these antibiotics containing ?-lactam ring was higher than that of other antibiotics,the resistance rate is almost 100%.However,they are sensitivity to the fourth generation of cephalosporins,and the drug resistance rate is about 40% to 50%.The drug resistance rates of Enterobacter and Klebsiella producing ESBLs to Carbapenems were about 4.0%,5.5% respectively.The drug resistance rate of Enterobacter producing ESBLs to piperacillin/tazobactam was 46.2%-66.7%,the drug resistance rate to cefoxitin was about 90%,the drug resistance rate to amikacin is about 15%.The drug resistance rate of Klebsiella producing ESBLs to piperacillin/tazobactam was 17.2%-29.4%,the drug resistance rate to amikacin is about 10%.Conclusion:1.The detection rate and drug resistance of Enterobacter and Klebsiella producing ESBLs increased gradually in our hospital,And the detection rate of CRE was also increasing.2.The drug resistance of Enterobacter and Klebsiella producing ESBLs is different at different times in our hospital.Choosing the reasonable treatment according to multiple factors.3.There were differences in drug resistance between Enterobacter and Klebsiella producing ESBLs,they might have other mechanisms of drug resistance.