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首页> 外文期刊>The Southeast Asian journal of tropical medicine and public health >THE DETERMINATION OF CARBAPENEM RESISTANCE IN ESCHERICHIA COLI AND KLEBSIELLA PNEUMONIAE ISOLATES RELATED TO NOSOCOMIAL INFECTIONS AND THE EVALUATION OF RISK FACTORS
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THE DETERMINATION OF CARBAPENEM RESISTANCE IN ESCHERICHIA COLI AND KLEBSIELLA PNEUMONIAE ISOLATES RELATED TO NOSOCOMIAL INFECTIONS AND THE EVALUATION OF RISK FACTORS

机译：与医院感染有关的大肠埃希氏菌和肺炎克雷伯菌肺炎克雷伯菌耐药性的测定及危险因素的评估

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摘要

We aimed to investigate carbapenem resistance, resistance mechanisms, risk factors and epidemiological features of Escherichia coli and Klebsiella pnenmoniae strains isolated from related infections in intensive care unit (ICU) patients. Car-bapenemase activity was determined by MHT, MBL Etest and enzyme extraction methods. Presence of extended-spectrum beta-lactamase (ESBL) and carbapenemase-encoding genes were investigated by PCR and sequencing. Clonal relationship of the strains was investigated by pulse field gel-electrophoresis. Acquired AmpC and Qnr were investigated by PCR. Throughout this study, 1,657 patients, and 11,483 hospitalization days were followed by active surveillance in the ICU of our 1,000-bed training hospital. Out of 108 of 196 patients, 130 E. coli- and K. pneumoniae-related nosocomial infections were determined. Minimum inhibitory concentration (MIC) levels of ertapenem were >1 mg/1 in 14 K. pneumoniae and 2 E. coli strains. The highest MIC level of carbapenem was found in K. pneumoniae and E. coli strains of >128 mg/1 and 8 mg/1, respectively. In the carbapenem resistant strains, KPC and MBL activity were not found. On the other hand, 14 strains of K. pneumoniae and one strain of ￡. coli exhibited OXA-48 beta-lactamase activity. Fifty-seven percent of K. pneumoniae isolates produced OXA-48 orginating from two clones and remaining isolates originated from different clones. Thus carbapenem resistance was determined as 22% and 3% in K. pneumoniae and ￡. coli strains, respectively. Invasive devices, duration of total parenteral nutrition, duration of hospitalization, presence of transfusions, ESBL and multiple drug resistance were found to be risk factors for carbapenem resistance.
机译：我们旨在调查重症监护病房（ICU）患者相关感染中分离出的大肠杆菌和肺炎克雷伯菌的碳青霉烯耐药性，耐药机制，危险因素和流行病学特征。通过MHT，MBL Etest和酶提取方法确定碳青霉烯酶的活性。通过PCR和测序研究了广谱β-内酰胺酶（ESBL）和碳青霉烯酶编码基因的存在。通过脉冲场凝胶电泳研究菌株的克隆关系。通过PCR研究获得的AmpC和Qnr。在整个研究中，在我们拥有1000张床位的培训医院的ICU中，对1,657例患者和11,483住院天进行了积极监测。在196例患者中的108例中，确定了130例与大肠杆菌和肺炎克雷伯菌相关的医院感染。在14例肺炎克雷伯菌和2株大肠杆菌中，厄他培南的最低抑菌浓度（MIC）水平> 1 mg / 1。碳青霉烯的最高MIC水平分别在肺炎克雷伯菌和大肠杆菌菌株中分别> 128 mg / 1和8 mg / 1。在耐碳青霉烯的菌株中，未发现KPC和MBL活性。另一方面，有14株肺炎克雷伯菌和1株￡。大肠杆菌表现出OXA-48β-内酰胺酶活性。 57％的肺炎克雷伯菌分离株产生的OXA-48来自两个克隆，其余的分离株则来自不同的克隆。因此，在肺炎克雷伯氏菌和肺炎克雷伯菌中，碳青霉烯的耐药性被确定为22％和3％。大肠杆菌菌株。侵入性器械，总肠胃外营养的持续时间，住院时间，输血的存在，ESBL和多重耐药性是碳青霉烯耐药性的危险因素。

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