• Weiping Liu, Yongfang Yang, Kai Zhang, Yunting Hai, Haoxue Li, Yueying Jiao, Huimin Xing, Binbin Xu, Haibo Bai, Yuping Zhao, Huan Bao, Shuai Zhang, Wei Ren, Lifang Yang, Huijun Yang, Junwei Tian, Meng Wang, and Tianhui Guo.
• Department of Nosocomial Infection Control, Inner Mongolia People's Hospital, Hohhot, China.
• Ann Palliat Med. 2020 Jul 1; 9 (4): 1545-1555.

BackgroundThe objective of this study was to understand the distribution and drug resistance of healthcare-associated infection (HAI) pathogens in an intensive care unit (ICU) of a general tertiary hospital in Inner Mongolia, and to classify carbapenem-resistant Acinetobacter baumannii (CR-AB) in ICU patients and environmental samples. Additionally, this study aimed to provide scientific evidence for the use of clinical antibiotics and effective prevention and control measures for CR-AB outbreak.MethodsThe distribution and drug resistance of pathogens isolated from patient's samples in the ICU of 12 Hospitals from January to May 2019 were retrospectively analyzed. Meanwhile, CR-AB isolated from patients and environmental samples were collected and classified by pulsed-field gel electrophoresis (PFGE).ResultsThe pathogens isolated from ICU samples, mainly Gram-negative bacteria (63.07%), were CR-AB, Klebsiella pneumoniae, and Pseudomonas aeruginosa; the main Gram-positive bacteria (22.13%) were Enterococcus faecium and Staphylococcus aureus; and fungi accounted for the remaining (14.80%). The samples mainly came from sputum (41.09%). Among non-fermenting bacteria, the resistance rates of CRAB to piperacillin, piperacillin/tazobactam, and other treatments were higher than those of Pseudomonas aeruginosa (P<0.05). Meanwhile, the resistance rates to ampicillin/sulbactam and compound sulfamethoxazole were lower than those of Pseudomonas aeruginosa (P<0.05). The resistance rates of Klebsiella pneumoniae to piperacillin/tazobactam, ceftazidime, and others were higher than those of Escherichia coli (P<0.05). Among Gram-positive bacteria, the resistance rates of Enterococcus faecium to erythromycin, clindamycin, and other treatment were higher than those of Staphylococcus aureus (P<0.05). A total of 62 bands were obtained from 63 strains of CR-AB by electrophoresis. Also, 16 clusters (A-P) were obtained with a 74% similarity coefficient, among which K, L, and N types (more than 9 strains) were more common.ConclusionsGram-negative bacteria were the primary pathogens of HAI in the ICU, and their drug resistance was serious. There is homology in the PFGE typing of CR-AB. Therefore, hospitals should strengthen the surveillance of drug-resistant pathogenic bacteria. Additionally, further cleaning and disinfection measures are needed to improve environmental hygiene and prevent outbreaks of HAI.

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