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Analysis the Mechanisms of Imipenem-resistant Pseudomonas Aeruginosa in ICU and Risk Factors

Author: LiuJiaTong
Tutor: CuiXueFan
School: Nanjing Medical University
Course: Department of Respiratory Medicine
Keywords: Intensive care unit Pseudomonas aeruginosa Imipenem Drug resistance genes Metallo-β-lactamase Risk factor class 1 integron
CLC: R446.5
Type: Master's thesis
Year: 2011
Downloads: 75
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Abstract


Objective:To investigate the drug resistance of Pseudomonas aeruginosa(PA) isolated from ICU in our hospital and the risk factors for IRPA infection and molecular mechanisms for carbapenem-resistant.To provide the evidence of reasonable selection of antibiotics and decreasing the resistance.Methods:The clinical strains of P. aeruginosa were collected from June 2009 to June 2010 in ICU.The results of antimicrobial susceptibility tests were analyzed. Antimicrobial susceptibility tests were performed by K-B methods, Metallo-β-lactamase genes, OprD2 gene and class 1 integron gene carried on IRPA were detected by PCR method. Retrospective study was performed to investigate risk factors that were relevant to the infections due to IRPA and data were analyzed by Chi-square test.Results:(1 Resistance profile:60 strains of PA were isolated from June2009 to June 2010, imipenem-sensitive and imipenem-resistant strains were 20 strains,40 strains respectively. The results of the resistant rate of imipenem-sensitive of PA against the 15 tested antibacterials are as follows:SXT has the hightest with the rate 95%, followed by ATM and AMK with 80% and 70%, respectively, and then followed by MH with 60%.40 imipenem-resistant strains are all MDRPA.(2)Specimen types:60 strains of PA were isolated from 5 different kinds of clinical specimen,sputum, BALF, blood, and so on, the mostly from sputum(90%) (3)Specimens origin:60 clinical specimens all came from ICU(4)Risk factors analysis:According to univariate analysis, the factors associated with the IRPA infection were.length of patient stay>2weeks,mechanical ventilation,tracheal intubation or incision of trachea,and previous carbapenems use.(5)Molecular epidemiology study of Carbapenem-resistant Pseudomonas aeruginosa:36 negative for OprD2 gene,36 positive for class 1 integron gene,4 positive for IMP-1 MBL by PCR. both gene of VIM, SPM and GIM were negative in all 40 imipenem-resistance PA strains. Conclusion(1)The present study demonstrates that drug resistant especially carbapenem resistant of PA was very serious in our hospital.Most of the resistant strains were isolated from sputum and all strains from patients in intensive care unit. (2) the factors associated with the IRPA infection were:length of patient stay>2 weeks,mechanical ventilation,tracheal intubation or incision of trachea,and previous carbapenems use. In order to prevent or slow down the development of resistant strains of PA, measures should be taken to use imipenem with very strict indications, to shorten length of stay in the ICU and days on ventilator,and to minimize the application of tube.(3).There were 4 IMP-1 genotypes detected in the 40 carbapenem-resistant strains indicating that metallo-lactamase might not be the important mechanism for resistance. The outer membrane protein OprD2 may play a very important role in the pathogenesis imipenem resistant of PA.these 40 clinical strains of IRPA,36 strains(90%)were positive of class I integron.4 strains(10%)were negative of metallo-β-lactamases and not losing of outer membrane proteins OprD2. The mechanisms for carbapenem resistant need further investigation.

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