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Title:
Drug Resistant Mechanism and Homology Analysis of Carbapenem-Resistant Enterobacteriaceae Isolated from Different Sites of One Patient in Intensive Care Unit
Authors:  Jinyi Gu, M.M., Wenli Yuan, M.D., Hongyun Xu, B.S., Chunlin Liu, M.M., Huan Zhang, B.S., Yuanyuan Guo, M.M., and Deyao Deng, B.S.
  Objective: To investigate the drug resistant mechanism and homology of carbapenem-resistant Enterobacteriaceae (CRE) isolated from different sites of one patient in the intensive care unit (ICU).
Study Design:
The active screening of CRE in fecal or anal swabs was carried out for patients in the ICU of a tertiary hospital in Yunnan. If CRE was colonized in fecal or anal swabs, some specimens (urine, sputum, drainage fluid, wound tissue, etc.) from other parts of the patient during the same period were collected to screen for CRE. The collected CRE were identified and tested for drug sensitivity and phenotypic validation, and the clinical data and laboratory results were analyzed. Carbapenem resistance genes were detected by polymerase chain reaction and sequenced. The homology of CRE isolated from different sites of one patient was analyzed by randomly amplified polymorphism DNA (RAPD) technique.
Results:
Of 1,518 patients in the ICU during the study period, 1,502 were involved in screening. The rate of active screening of CRE was 98.95% (1502/1518), the rectum colonization rate of active screening of CRE was 4.73% (71/1502), the rate of CRE detected only in rectum was 25.35% (18/71), the rate of CRE detected in 2 parts was 11.27% (8/71), the rate of CRE detected in 3 parts was 49.30% (35/71), the rate of CRE detected in 4 parts was 14.08% (10/71), and carbapenem-resistant Klebsiella pneumoniae (CRKP) strains were dominant among the pathogens, accounting for 87.32% (62/71). All the CRE screened from ≥2 parts were CRKP. The results of drug sensitivity and phenotypic validation of CRE isolated from different sites of 1 patient were the same. The positive rate of carbapenem resistance genes KPC-2, NDM-1, VIM-2, and IMP, respectively, were 69.83%, 17.32%, 8.38%, and 6.70%; the gene OXA-48 was not detected. The type of carbapenem resistance genes was the same (92.45%). One hundred sixty-one strains of CRE isolated from ≥2 sites of 1 patient were classified into 7 different clones by the RAPD technique, and the clone D was epidemic strain. CRE isolated from different sites of 94.34% of patients were from the same clone.
Conclusion:
Carrying the KPC-2 gene is the main cause leading to drug resistance of CRE isolated from a patient, and the CRE isolated from different sites of 1 patient have higher relatedness. It is necessary to actively screen for CRE and to strengthen prevention and control measures in-clinic and the therapy method for patients with CRE colonization and infection by early detection, early intervention, and early treatment.
Keywords:  active screening; antibiotics, carbapenems; carbapenem-resistant Enterobacteriaceae; carbapenems; Enterobacteriaceae; multiple-site infection
   
   
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