Objective To investigate the predictors for carbapenem-resistant Acinetobacter baumannii, Enterobacteriaceae and Pseudomonas aeruginosa (CR-AEP) as the pathogens of bloodstream infection (BSI) for intensive care unit (ICU) patients. Methods A retrospective case-control study based on ICU- healthcare-associated infection (HAI) research database was carried out. The patients who have been admitted to the central ICU between 2015 and 2019 in the ICU-HAI research database of West China Hospital of Sichuan University were selected. The included patients were divided into two groups, of which the patients with ICU-acquired BSI due to CR-AEP were the case group and the patients with BSI due to the pathogens other than CR-AEP were the control group. The clinical features of the two groups of patients were compared. Logistic regression model was used to identify the predictors of BSI due to CR-AEP.ResultsA total of 197 patients with BSI were included, including 83 cases in the case group and 114 cases in the control group. A total of 214 strains of pathogenic bacteria were isolated from the 197 BSI cases, including 86 CR-AEP strains. The results of multivariate logistic regression analysis showed that previous use of tigecycline [odds ratio (OR)=2.490, 95% confidence interval (CI) (1.141, 5.436), P=0.022] was associated with higher possibility for CR-AEP as the pathogens of BSI in ICU patients with BSI, while previous use of antipseudomonal penicillin [OR=0.497, 95%CI (0.256, 0.964), P=0.039] was associated with lower possibility for that. Conclusion Previous use of tigecycline or antipseudomonal penicillin is the predictor for CR-AEP as the pathogens of BSI in ICU patients with BSI.
Objective To analyze the drug resistance genes, virulence genes and homologies of carbapenem-resistant Klebsiella pneumoniae (CRKP) colonized and infected patients in surgical intensive care unit based on whole genome sequencing. Methods Whole genome sequencing analysis was performed on CRKP infected strains isolated from the Department of General Surgery Intensive Care Unit and the Department of Liver Surgery Intensive Care Unit of Zhongshan Hospital, Fudan University in March 2021 and CRKP colonized strains isolated from the above departments between January and March 2021. The drug resistance genes, virulence genes and homologies of the strains were analyzed. ResultsA total of 16 CRKP strains were included, including 10 colonized strains and 6 infected strains. Except for the β-lactamase drug resistance gene CTX (16.7% vs. 100.0%, P<0.05), there was no significant difference in the detection rate of other drug resistance genes between CRKP infected strains and colonized strains (P>0.05). The cluster analysis of drug resistance genes of some strains was relatively close. Whole genome sequencing analysis showed that CRKP strains carried a variety of virulence genes, and the detection rates of entB, irp2, iroN, and rmpA genes were 100.0%, 87.5%, 37.5%, and 62.5%, respectively. There was no significant difference in the detection rate of virulence genes between CRKP infected strains and colonized strains (P>0.05). Homology analysis showed that some strains had close homologous relationships, and there was the possibility of cross transmission. Conclusions Some of CRKP infection strains and colonization strains in surgical intensive care unit patients have the risk of cross transmission. In the future, we should strengthen the prevention and control of nosocomial infection to reduce the incidence of infection.
Objective To compare the clinical efficacy of intravenous polymyxin B alone and intravenous drip combined with nebulized inhaled polymyxin B in treatment of patients with carbapenem-resistant organism (CRO) pneumonia. Methods The clinical data of 85 patients with CRO pneumonia admitted to the Intensive Care Unit of Nanjing Drum Tower Hospital from September 2020 to June 2023 were collected using a retrospective study. According to the different ways of administration of polymyxin B, the patients receiving polymyxin B intravenous drip therapy alone were included in group A, and the patients receiving polymyxin B intravenous drip therapy combined with nebulized inhalation therapy were included in group B. The therapeutic effective rate, bacterial clearance rate, 30-day all-cause mortality and the level of infection indexes before and after the use of medication were compared between the two groups. The occurrence of acute kidney injury during the use of drugs in the two groups was observed and recorded. Results The pathogenicity culture results showed that there was no statistically significant difference between the two groups (P=0.144). Serum procalcitonin and C-reactive protein were significantly lower in the two groups after drug administration compared with those before drug administration (both P<0.05). The therapeutic efficiency and bacterial clearance rate in group B were higher than those in group A (both P<0.05). There was no statistically significant difference in 30-day all-cause mortality between the two groups (P=0.664). And there was no statistically significant difference in the incidence of adverse reactions between the two groups (P=0.650). Conclusion When polymyxin B is used to treat patients with CRO pneumonia, the intravenous drip combined with nebulized inhalation regimen is superior to intravenous drip therapy alone and does not increase the risk of developing nephrotoxicity.
Liver transplantation is a most curative treatment for end-stage liver diseases. However, postoperative infection, especially the multi-drug resistant organisms infection, could contribute to the mortality after liver transplantation. Therefore, how to identify and prevent multi-drug resistant bacterial infection is the key to achieve improved postoperative outcomes after liver transplantation. The team of West China Hospital of Sichuan University, in collaboration with multiple Chinese medical centers, draw on the mature experiences of advanced countries in the field of transplantation jointly formulated the “Multicenter expert consensus on prevention and treatment of infections caused by multi-drug resistant organisms after liver transplantation”. The consensus had been developed around aspects such as epidemiological characteristics, antimicrobial uses, and prevention measurements of multi-drug resistant bacterial infection after liver transplantation.