Objective To clarify the epidemiological characteristics, distribution of drug-resistant genes, and risk factors of multidrug-resistant Enterobacteriaceae (with a focus on Klebsiella pneumoniae and Escherichia coli) infections in inpatients at Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine in 2024, and to provide data support for targeted clinical prevention and control. Methods A retrospective analysis was conducted on 116 cases of inpatients with multidrug-resistant Enterobacteriaceae infections in our hospital in 2024, from whom multidrug-resistant Enterobacteriaceae strains were clinically isolated. Among these strains, there were 41 carbapenem-resistant Enterobacteriaceae (CR-E) strains and 75 extended-spectrum β-lactamase (ESBL) -producing Enterobacteriaceae strains. The VITEK MS system was used for bacterial species identification, while the VITEK 2 Compact system or Kirby-Bauer (K-B) method was applied for drug susceptibility testing. ESBL was detected via the double-disk synergy test. The modified Hodge test and metalloenzyme screening test were used to confirm the carbapenemase phenotype. Polymerase chain reaction (PCR) amplification was performed to detect drug-resistant genes (KPC, NDM, and VIM types for CR-E; TEM, CTX-M, and SHV types for ESBL-producing bacteria). Multivariate Logistic regression analysis was used to identify the risk factors for infection. Results Among the 116 infection cases, CR-E was mainly composed of Klebsiella pneumoniae (48.78%, 20/41) and Escherichia coli (31.71%, 13/41), with resistance rates of 80.49% (33/41) to imipenem and 78.05% (32/41) to meropenem. ESBL-producing bacteria were predominantly Escherichia coli (72.00%, 54/75) and Klebsiella pneumoniae (20.00%, 15/75). For CR-E, the detection rate of KPC-type drug-resistant genes was the highest (51.22%, 21/41), followed by NDM-type (34.15%, 14/41). For ESBL-producing bacteria, the detection rate of TEM-type drug-resistant genes was the highest (62.67%, 47/75), followed by CTX-M-type (48.00%, 36/75). Multivariate Logistic regression analysis showed that admission to the intensive care unit (ICU) (OR=3.49, 95% CI: 1.75-6.95, P<0.001), previous use of antibacterial agents (OR=2.41, 95% CI: 1.39-4.16, P=0.002), and invasive procedures (OR=2.77, 95% CI: 1.48-5.19, P=0.001) were independent risk factors for infection. Conclusion In 2024, multidrug-resistant Enterobacteriaceae infections in inpatients at our hospital were mainly caused by carbapenem-resistant Klebsiella pneumoniae and ESBL-producing Escherichia coli. KPC-type and TEM-type genes were the main drug-resistant genes in these two types of bacteria, respectively. Admission to the ICU, previous use of antibacterial agents, and invasive procedures were key risk factors. Targeted measures should be strengthened for clinical prevention and control.
Key words
multidrug-resistant enterobacteriaceae /
Klebsiella pneumoniae /
Escherichia coli /
drug-resistant genes /
bacterial infection
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References
[1] ADEDIRAN T, HARRIS AD, JOHNSON JK, et al. Epidemiologic and Microbiologic Characteristics of 28 Hospitalized Patients Cocolonized With Multiple Carbapenem-Resistant Enterobacteriaceae (CRE) in the United States[J]. Open Forum Infect Dis, 2020, 7(10): ofaa386.
[2] 张玉敏, 顾全, 韩素桂, 等. 碳青霉烯类耐药肠杆菌科细菌耐药基因分型与临床感染分析[J]. 热带医学杂志, 2022, 12(4): 23-30.
[3] NIEKO D M P N, MORABANDZA J C, KAYAONGOTO D M, et al. First Detection of Fluoroquinolones and Aminoglycosides Resistance Genes in Multiresistant Enterobacteriaceae from Urinary Tract Infections[J]. Am J Infect Dis Microbiol, 2022, 10(4): 131-138.
[4] PIOTROWSKA MJ, SAKOWSKI K, HORN J, et al. The effect of re-directed patient flow in combination with targeted infection control measures on the spread of multi-drug-resistant Enterobacteriaceae in the German health-care system: a mathematical modelling approach[J]. Clin Microbiol Infect, 2023, 29(1): 109. e1-109. e7.
[5] ZENAWORK S, GETABALEW E, DEMISSEW S, et al.High Prevalence of Multi-Drug Resistance and Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae Among Hospitalized Patients Presumptive for Bacterial Infection at Debre Berhan Comprehensive Specialized Hospital, Ethiopia.[J]. Infect Drug Resist, 2022, 15(26): 2639-2656.
[6] HEYAM A, MAAYAN H, SHIMRIT H, et al.Interventions to reduce infections caused by multidrug resistant Enterobacteriaceae (MDR-E): a systematic review and meta-analysis.[J]. J Infect, 2021, 83(2): 156-166.
[7] SRUJANA M, ASHOKA M .In vitro activity of tigecycline against multidrug-resistant Enterobacteriaceae isolates from skin and soft tissue infections[J]. Ann Med Surg (Lond), 2021, 62(12): 228-230.
[8] IACOB O A C, TOADER S V, OVIDIU N P. Evaluation of the Prevalence of ESBL Multi-Resistant Bacteria, Carbapenemase Producing Enterobacteriaceae in Urinary Tract Infections[J]. Internal Medicine, 2020, 17(6): 19-24.
[9] 杨红梅, 高靖, 刘丽, 等. 唐山市碳青霉烯耐药肠杆菌科细菌分布及耐药基因检测[J]. 中国消毒学杂志, 2024, 41(5): 330-334.
[10] 刘超梅, 闫晓芳, 宿瑞俊, 等. 临床常见多重耐药菌分布特点及耐药性[J]. 中国国境卫生检疫杂志, 2024, 47(1): 92-95.
[11] 吴超, 邵永惠, 徐清清, 等.2020-2021年西部地区某综合三甲医院住院患者多重耐药菌流行现况分析[J]. 华南预防医学, 2023, 49(11): 1467-1471.
[12] 王雨豪. 多黏菌素B治疗碳青霉烯类耐药肠杆菌科细菌感染的研究进展[J]. 重庆医学, 2022, 10(15): 51-55.
[13] 蔡秀怡, 王宏波, 谭志霞, 等. 湖南某医院526例糖尿病并发泌尿系统感染患者的细菌分布及耐药性分析[J]. 湖南师范大学学报 (医学版), 2024, 21(3): 141-145.
[14] 张露丹, 周丹, 刘宝, 等.2015—2019年贵州省某三甲医院分离细菌的分布及对常用抗菌药物的耐药率变化[J]. 贵阳医学院学报, 2021, 10(5): 46-50.
[15] 吴建, 刘融星, 陈晓玲, 等. 老年重症肺炎患者医院感染的相关因素及防控策略分析[J]. 湖南师范大学学报 (医学版), 2022, 12(5): 117-123.
[16] 何倩, 赵红, 柯银凤, 等. 某综合性中医院2014年-2018年碳青霉烯耐药肠杆菌科细菌分布特点和医院感染情况分析[J]. 华西医学, 2020, 35(3): 6-9.
[17] 陆书华, 李晓哲, 刘凌云, 等. 山东某院耐碳青霉烯类肠杆菌科细菌临床感染特征及耐药基因分析[J]. 检验医学, 2020, 35(8): 6-10.
[18] 罗碧琚. 呼吸科多重耐药菌感染的病原菌及易感因素的探讨[J]. 黑龙江医药, 2024, 37(1): 103-105.
[19] 刘海燕. 某三甲医院碳青霉烯类耐药肠杆菌科细菌感染的临床特征和多重危险因素分析[J]. 青海医药杂志, 2023, 53(12): 9-12.
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