The research of using GeneXpert method to detect Carbapenem-resistant Klebsiella pneumoniae resistance genes in a hospital of Shenyang

Objective To detect drug-resistant trend in Carbapenem-resistant Klebsiella pneumoniae, we used GeneXpert method to detect the case of resistant genes and provided experimental basis for guide clinical rational drug use.To provide the reference for prevention and control of carbapenems in Carbapenem-resistant Klebsiella pneumoniae infection and outbreak. Methods 60 strains of Carbapenem-resistant Klebsiella pneumoniae which culture and separation from clinical of shengjing hospital affiliated to China Medical University from January 2013 to June 2017 were collected.Repetitive strains from same patients were eliminated.We used VITEK 2 Compact automatic bacteria identification instrument to identify the bacteria, and Kirby-Bauer method to further determine the preliminary screening of Carbapenem-resistant Klebsiella pneumoniae strains.GeneXpert method was used to detect five kinds of resistant genes (KPC, NDM, IMP-1, OXA-48, VIM). Results Carbapenem-resistant Klebsiella pneumoniae was the most sensitive to amikacin, up to 78.95%; The sensitivity rates of levofloxacin and ciprofloxacin were 48.28% and 43.10% respectively; The sensitivity rates of gentamicin, tobramycin and cotrimoxazole were 37.93%, 35.71% and 29.31% respectively; The sensitivity rate of nitrofurantoin was 5.26%, the intermediary rate was 28.95%; The sensitive rate of aztreonam, piperacillin/tazobactam, cefotetan, cefepime, ceftriaxone, cefazolin, ampicillin/sulbactam were during 0%-15.52%.The result of GeneXpert method to detect five kinds of resistant genes were 49 strains carry carbapenemases, accounted for 81.67%.11 strains did not carry carbapenemase, accounted for 18.33%.19 strains (31.7%) carried a single KPC enzyme, 18 strains (30%) carried a single NDM enzyme, 1 strain (1.7%) carried a single IMP-1 enzyme, 9 strains (15%) both carried KPC and NDM enzyme, 1 strain (1.7%) both carried KPC and IMP-1 enzyme, 1 strain (1.7%) also carried IMP-1, KPC and NDM enzyme.The remaining type of resistance gene was not detected.The minimal inhibitory concentration of imipenem and whether detected were statistically significant, the strains which detected resistance genes were more resistant to imipenem.There showed no significant difference between the number of resistant genes and the prognosis of patients. Conclusions In our hospital, Carbapenem-resistant Klebsiella pneumoniae were multi-drug resistance, the situation is not optimistic.Amikacin can be selected as a therapeutic drug.The high enzyme production suggesting that drug resistance genes are rapidly spread which should cause clinical and scientific research attention.GeneXpert method as a rapid gene level detection of new method of infectious pathogens deserves attention. Key words: Klebsiella pneumoniae; Microbial sensitivity tests; Gene; Carbapenemases