Screening Of Enterobacteriaceae Bacteria Resistant To Carbapenems In Intensive Care Patients In The Department Of Neurology

BackgroundSince the first separation of carbapenem resistant Enterobacteriaceae(CRE)in the United States in 2001,the separation rate has gradually increased in recent years,including some countries in the United States,Europe,South America,China,southeast Asia and other countries are high incidence areas.Due to the increasingly serious prevalence and drug resistance of CRE in the world,more and more countries and regions begin to pay attention to the early screening and prevention of CRE.In China,the data of China bacterial resistance monitoring network(CARSS)shows that the drug resistance rate of Klebsiella Pneumoniae to Carbapenems antibiotics has risen rapidly from 3%to 15%from 2005 to 2015,and the drug resistance rate of some cities has reached as high as 20%.As early as 2015,the Centers for Disease Control and Prevention(CDC)pointed out that invasive CRE infections can cause a mortality rate of up to 40%to 50%,and patients infected with CRE are twice as likely to die than those infected with bacteria sensitive to Carbapenems.These data reveal a significant risk of CRE infection,especially for critically ill patients in Intensive Care Units(ICUs).They are more likely to be infected with CRE than non-ICU patients due to severe decline in their own immunity,complex underlying diseases and the use of various auxiliary pipelines and machines.In addition,as the abuse of carbapenems in recent years has brought great difficulties to the treatment of CRE infection,some studies have shown that the mortality rate of ICU inpatients who developed CRE infection at 90 days is significantly increased.For neurology intensive care unit,on the one hand,the majority of patients for the disturbance of consciousness,activity obstacle,language barriers and malnutrition,patients must maintain stable vital signs by means of various medical measures,including a variety of catheterization(urine pipe,gastric and venous catheter,endotracheal intubation,etc.)all kinds of invasive operations(sputum suction,catheter,stomach tube,piercing,bronchoscope,trachea incision,etc.)respirator assisted ventilation,etc.On the other hand,these patients could not express their ideas clearly,they must stay in bed for a long time,be irritable and have a catheter placed in bed for a long time,so,the incidence of lung aspiration infection and urinary tract infection was increased,which all will significantly increase the risk of CRE infection.It can be seen that for severe patients in NCU,CRE screening at the early stage of admission is particularly important.Screening and identifying potential infections in advance can not only protect severe patients,but also prevent and cure nosocomial fulminant infections.This study aims to retrospectively analyze the CRE screening resulits in Neurology Care Unit patients in August 2018 to August 2019,to conclude the related risk factors of NCU,common CRE strain type,drug susceptibility results,common clinical characteristic,outcome after antibiotic use and so on,in order to find more conducive suggestions to early prevention and isolation measures,to be more effective to prevent outbreak of nosocomial infection,and to further reduce the follow-up treatment difficulty.Method1.Collecting the results of CRE screening in various departments in jingzhou central hospital from August 2018 to August 2019.2.Analyzing the data,with emphasis on the CRE screening in the neurology intensive care unit.3.Analyzing the clinical characteristics of patients with positive CRE initial screening in the NCU.4.To obtain the strain types and distribution of CRE initial screening positive rate in the hospital from 2018 to 2019.5.To obtain the initial screening positive rate of CRE,common strains,characteristics of drug susceptibility,common infection site and clinical characteristics,and correlation with basic diseases in the neurology intensive care unit in 2018-2019.Results1.From August 2018 to August 2019,a total of 490 patients were screened for CRE in Jingzhou Central Hospital(excluding repeated screening cases),includ 8 departments:the department of Rehabilitation,department of Neurosurgery,department of Neurology,Intensive Care Unit,department of Respirator,department of Neurosurgery,department of Hematology,department of Urology,department of Stomatology.Among them,the main samples(343 cases)were submitted from the Neurology Intensive Care Unit for examination,accounting for 70%(343/490).2.Six types CRE strains were screened out from the total of 490 cases of samples,including 34 positive cases,respectively,for e.coli(22 cases),klebsiella pneumoniae(7 cases)sewers e.coli(5 cases)freund's citric acid bacillus bacteria(2 cases)Hector's Mr Bush(1 case)and vegetative klebsiella bacteria(1 case).Neurology Care Unit samples,a total of 343 cases of early screening positive for 13 cases,e.coli,respectively(9 cases)sewers e.coli(3 cases)freund's citric acid bacillus(1 case)and Hector's Mr Bush bacteria(1 case),two bacteria(enterobacter cloacae and escherichia hernieri)were screened from one patient.3.The positive rate of CRE screening in the whole hospital from 2018 to 2019 was about 6.94%(34/490).The positive rate of CRE screening in the neurology intensive care unit from 2018 to 2019 was about 2.65%(13/490).Among the strains screened in the whole hospital,escherichia coli was mainly in the neurology intensive care unit(9/22).Klebsiella pneumoniae was mainly in the department of hematology(4/7).Enterobacter cloacae was mainly in the neurology intensive care unit(3/5).Other strains were scattered.4.In the 13 cases with positive screening results for carbapenems resistant enterobacteriaceae bacteria in the neurology intensive care unit,4 strains were detected,e.coli,e.cloacae,e.citrobacter and e.hershella,respectively.5.The most positive screening rate of enterobacteriaceae bacteria resistant to carbapenems in the hospital was in August and November.And the neurology intensive care unit is in November.6.The factors related to positive CRE screening in the neurology intensive care unit may include:severity of illness,basic disease,transfer to other hospitals and infection before admission.7.Among the 13 patients with positive CRE screening in the neurology ward,9 patients had pulmonary infection,2 patients had urinary tract infection and 2 patients had sepsis.8.Drug sensitivity analysis of 13 positive screening cases:in the department of neurology:among the 9 cases of escherichia coli,7 cases(77.8%)were strains sensitive to aminoglycosides(amikacin gentamycin and tobramycin).There were 5 cases(55.6%)of strain sensitive to compound xinnomin.There were 3 furantoin sensitive strains,accounting for 33.3%.There were 2 cases(22.2%)of tega-sensitive strains.Imipenem sensitive strains were found in 2 cases(22.2%).The rest were 1 case(11.1%)sensitive to amtronan,1 case(11.1%)sensitive to piperacillin/tazobactam,and 1 case(11.1%)sensitive to ceftetan.Among the 3 cases of enterobacter cloacae,2 cases(66.7%)were susceptible to amikacin,and one case was intermediate.There was 1 case(33.3%)of tegacycline-sensitive strain.One Citrobacter fusei was sensitive to aminoglycoside(amikacin gentamicin)furantoin and aminotramine.One Escherichia hirsutum was sensitive to amikacin.Conclusion1.Escherichia coli dominated CRE screening in the intensive care unit of neurology department of jingzhou central hospital.2.Most of the strains obtained from screening were in the state of colonization,and less severe infections were caused.The most common infection was pulmonary infection,followed by urinary tract infection and sepsis.3.Patients in the neurology ward are more likely to develop post-transplant infection,especially those with a high degree of disease severity,complex underlying diseases,transferred to other hospitals for multiple times,with a long history of hospitalization in other hospitals,multiple drug-resistant bacterial infections were present before admission and so on.4.Drug susceptibility results of strains screened in the laboratory indicated that enterobacteriaceae bacteria resistant to carbapenems in our department were basically sensitive to amikacin,suggesting that amikacin could be used for anti-infection treatment when CRE infection was suspected in patients.5.For patients newly admitted to the neurology intensive care unit with early signs of infection,an empiric anti-infective treatment is available:penicillin(piperacillin sulbaztam)or third-generation cephalosporins(ceftadime)combined with quinolones(levofloxacin moxifloxacin).It has certain effect on the control of infection symptoms.At the same time,it is necessary to strengthen the early isolation and prevention of patients,so as to avoid further infection and other patients' infection resulting in the outbreak of infection in the intensive care unit.