Risk factors for multidrug-resistant organisms infections in neurosurgery intensive care unit patients and association with TLR4 gene polymorphisms

OBJECTIVE To explore the risk factors for multidrug-resistant organisms (MDROs) infections in neurosurgery intensive care unit (ICU) patients and analyze the association with Toll-like receptor 4 (TLR4) Thr399Ile gene polymorphisms. METHODS A total of 110 neurosurgery ICU patients who were treated in the Second Affiliated Hospital of Nantong University from Mar 2020 to May 2021 were recruited as the research subjects and were divided into the study group with 34 cases and the control group with 76 cases according to the status of MDROs infection. The genotypes of TLR4 Thr399Ile were compared between the two groups, the incidence of MDROs infections was observed, and the multivariate regression analysis was performed for risk factors for the MDROs infections in the neurosurgery ICU patients. RESULTS The frequency of T allele at TLR4 Thr399Ile locus of the study group was significantly higher than that of the control group, while the frequencies of CC genotypes and C allele of the study group were significantly lower than those of the control group (P<0.05). Totally 41 strains of MDROs were isolated from the 34 patients with MDROs infections, 19 (46.34%) of which were gram-positive bacteria, and 22 (53.66%) were gram-negative bacteria. Methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus strains were highly resistant to penicillin, erythromycin and oxacillin, and no strains were found to be resistant to vancomycin and tigecycline. Carbapenem-resistant Klebsiella pneumoniae and carbapenem-resistant Acinetobacter baumannii strains were highly resistant to imipenem and meropenem, while the drug resistance rates to tetracycline were low. The result of logistic regression analysis showed that length of ICU stay, mechanical ventilation duration and TLR4 Thr399Ile locus T gene were the risk factors for MDROs infections in the neurosurgery ICU patients. CONCLUSION The TLR4 Thr399Ile locus T gene is a susceptibility gene for MDROs infections in the neurosurgery ICU patients. It is necessary for the hospital to formulate prevention measures based on the high-risk factors such as length of ICU stay more than 7 days and mechanical ventilation duration more than 7 days.