Analysis Of MDRPA In The Second People's Hospital In Jiulongpo District And A Preliminary Study On The Genes Of Drug Resistance

Objective The distribution and drug resistance of multiple drug resistant.Pseudomonas aeruginosa(MDRPA)were analyzed in the second people's Hospital of Jiulongpo District,Chongqing,and the detection of drug resistance genes was carried out.The preliminary study was carried out from the aspects of ?-lactam and aminoglycoside related drug resistance genes,OprD2 gene deletion of outer membrane protein.In order to understand the drug resistance and mechanism of multidrug-resistant Pseudomonas aeruginosa in our hospital,and provide reference for clinical control of infection,rational use of antibiotics and delay the production of bacterial resistance.Methods Collected and preserved 1287 non-duplicate PA strains clinically isolated from the second people's hospital of jiulongpo district,from January 2016 to December 2018.VITEK 2 COMPACT was used to identify bacteria.K-b method was used to detect the drug sensitivity test of PA clinical isolates to 11 commonly used antibiotics,and the above drug sensitivity results were statistically analyzed,and MDRPA was screened.A total of 1287 strains of PA were divided into the MDRPA infection group and the non-multi-drug-resistant pseudomonas aeruginosa infection group by case-control method.In this study,15 MDRPA patients in our hospital in December 2018 were selected as the research objects.Drug resistance genes of MDRPA were detected by Real time PCR and the mechanism of MDRPA was analyzed.Results(1)Among 1287 PA infected patients,885 were MDRPA,and the detection rate of MDRPA was 68.76%.PA has high resistance to cephalosporins and carbapenems,and high sensitivity to penicillin+enzyme inhibitors and aminoglycosides.The drug resistance rate of MDRPA group was higher than that of non MDRPA group(P<0.05).There was no significant difference in sex,age,specimen source,disease type,drainage,indwelling catheter,second-generation cephalosporin,fourth generation cephalosporin,aminoglycosides,fluoroquinolones and enzyme inhibitors between the two groups(P>0.05).Logistic regression analysis confirmed that the independent risk factors of mdrpa were ICU,basic diseases,hospital stay,mechanical ventilation,endotracheal intubation,surgery,time of use of antibiotics,three generations of cephalosporins,carbapenems,glycopeptides,antifungal drugs and antimicrobial drugs.(2)MDRPA main resistance genes in beta lactam type of antibiotic resistance genes and aminoglycoside antibiotic resistance genes,including the following TEM,CTX-M-1,DHA,OprD2,aac(6')-?,ant(2',')-?,ant(3',')-? altogether seven genetic loci.Among the MDRPA resistance genes,6 cases(40.0%)were detected by TEM gene,9 cases(60.0%)by ctx-m-1 gene,8 cases(53.3%)by DHA gene,and 6 cases(40.0%)by OprD2 gene.Aminoglycoside resistance aac(6')-? gene detection,8 cases(53.3%),the ant(2 ',')-? gene detection,6 cases(40.0%),the ant(3 '')-I gene detection,6 cases(40.0%).No drug-resistant gene expression was detected in 4 patients(26.6%).Single drug-resistant gene expression was detected in 2 cases(13.3%).Simultaneous expression of multiple drug resistance genes was detected in 9 cases(60.0%).Conclusion The independent risk factors for the occurrence of MDRPA in the second people's Hospital of Jiulongpo District,Chongqing are staying in ICU,accompanied by basic diseases,long hospitalization time,mechanical ventilation,endotracheal intubation,interventional operation,long use time of antibacterial drugs,use of three generations of cephalosporins,carbapenems,glycopeptides,antifungal drugs,and use of a variety of antibacterial drugs at the same time.Mdrpa has a high resistance rate to cephalosporins and carbapenems,but a high sensitivity rate to penicillin+enzyme inhibitors and aminoglycosides.The mechanism of mdrpa is complex,which is related to the emergence of ?-lactam and aminoglycoside antibiotic resistance genes.The related genes of MDRPA to?-lactam antibiotics mainly include TEM,ctx-m-1,DHA,oprd2,and the related genes to aminoglycoside antibiotics mainly include AAC(6 ')-?,ant(2,)-?,ant(3')-?.Many kinds of drug resistance have been detected The simultaneous expression of MDRPA gene in 9 cases(60.0%)indicated that multiple drug resistance genes were involved in the multidrug resistance of MDRPA.The current situation of MDRPA infection and drug resistance is not optimistic.It is necessary to further strengthen the monitoring of MDRPA resistance and study the molecular epidemiology of MDRPA resistance genes,formulate a more scientific treatment plan for the hospital and local infection,prevent the spread of drug-resistant strains,reduce the incidence of hospital infection,and impprove the clinical infection cure rate of Pseudomonas aeruginosa.