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Ziye Liu,1 Meiyu Deng,2 Bu Wang,2 Jianhua Liu,2 Wei Zhang,3,&ast; Jianqing Zhao2,&ast; 1Department of Respiratory Medicine, The First School of Clinical Medicine, Hebei North University, Zhangjiakou, Hebei, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, People’s Republic of China; 3Hebei Key Laboratory of Pathogenic Mechanisms and Diagnosis & Treatment Technologies for Lung Microbiome, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jianqing Zhao, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, People’s Republic of China, Email jq.zhao66@163.com Wei Zhang, Hebei Key Laboratory of Pathogenic Mechanisms and Diagnosis & Treatment Technologies for Lung Microbiome, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, People’s Republic of China, Email 15369318318@163.comPurpose: This study aims to investigate the prevalence of resistance genes, efflux pump genes, and biofilm-forming genes in carbapenem-resistant Acinetobacter baumannii, as well as the clinical characteristics of patients infected with carbapenem-resistant Acinetobacter baumannii, in order to provide guidance for rational clinical prevention and control.Methods: This study included 244 patients with CRAB infections admitted to a tertiary hospital in Zhangjiakou, China, between June 2021 and December 2024. Statistical analysis was performed using SPSS 27.0 software to investigate potential risk factors for mortality associated with CRAB. Conventional PCR amplification was used to qualitatively detect resistance genes, efflux pump genes, and biofilm-related genes in isolated CRAB strains. Biofilm formation capacity was assessed using the crystal violet staining method. The study analyzed the association between the aforementioned genetic and phenotypic characteristics, biofilm formation capacity, and antibiotic resistance.Results: A total of 244 CRAB isolates were collected in this study, primarily from sputum (55.33%), followed by bronchoalveolar lavage fluid (26.23%). The majority of isolates originated from the ICU (48.77%), followed by the Department of Respiratory Medicine (31.15%). PCR results showed that the predominant resistance genes in CRAB isolates from this hospital were blaOXA-51 and blaOXA-23, at 89.3% and 87.3%, respectively. The detection rates for blaNDM, blaOXA-58, and blaOXA-24 were 1.6%, 1.2%, and 0.4%, respectively. The efflux pump genes adeB, adeR, adeS, and adeJ all showed high detection rates, while the adeG gene was not detected. The biofilm-related genes with generally high detection rates were bap (240/244, 98.4%), abaI (227/244, 93.0%), and ompA (223/244, 91.4%); the detection rates of the remaining genes ranged between 84.8% and 90.6%. Of the 244 CRAB strains tested in this study, the vast majority (97.95%) possessed biofilm-forming ability. The OD values of the strains were determined using the crystal violet method, with weak biofilm-forming strains (47.54%) and moderate biofilm-forming strains (44.26%) predominating; strong biofilm-forming strains accounted for 6.15%, while strains incapable of biofilm formation accounted for only 2.05%. Antimicrobial susceptibility testing revealed that 99.58% of the 244 CRAB strains were resistant to piperacillin/tazobactam, and 99.15% were resistant to imipenem and meropenem. Resistance rates for amoxicillin/clavulanate, cefepime, ceftazidime, ceftiofur, ciprofloxacin, and levofloxacin, all exceeded 95%, while 3.08% were resistant to tigecycline. No resistance to polymyxin was observed. Results of multivariate logistic regression analysis showed that age (OR = 1.044, 95% CI: 1.009– 1.079, P < 0.05) and white blood cell count (OR = 1.106, 95% CI: 1.029– 1.188, P < 0.05) were independent risk factors for mortality in CRAB infections.Conclusion: In this study, CRAB strains were primarily isolated from the lungs (81.56%) and mainly originated from the ICU and respiratory department. CRAB strains exhibited extremely high resistance rates to most commonly used antimicrobial agents; specifically, resistance rates to 9 antimicrobial agents, including piperacillin/tazobactam, imipenem, and meropenem, were all > 90%. Only tigecycline showed a relatively low resistance rate (3.08%), and no resistance to polymyxin was detected. The CRAB strains in our hospital primarily harbor the blaOXA-23 and blaOXA-51 resistance genes and commonly carry efflux pump and biofilm formation genes, suggesting that their resistance may be closely associated with carbapenemases, efflux pump systems, and biofilm formation.Keywords: Acinetobacter baumannii, carbapenem resistance, genes, efflux pumps, biofilms
