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某區域教學醫院中院內感染ESBL Klebsiella pneumoniae的分子流行病學及藥物感受性探討

Molecular Epidemiology and Susceptibility of extended-spectrum β-lactamase-producing Klebsiella pneumoniae at a Teaching Hospital in Taiwan

摘要


雲林地區某區域教學醫院在2002及2003年培養出Klebsiella pneumoniae院內總臨床分離株數分別爲732及764株。其中ESBL-producing之院內感染菌株分別爲183(25.0%)及184(24.1%)株,此盛行率遠高於文獻報告。爲了探討該醫院ESBL-producing K. pneumoniae (ESBL-KP)菌株之抗生素感受性情況,並探討是否有特定菌株出現菌株散播(clonal spread)的現象導致盛行率偏高,我們進行了如下的研究。於2003年10月到2004年5月自該區域教學醫院收集共52株ESBL-KP院內臨床菌株,利用E-test測定下列抗生素:ampicillin, cephalothin, cefuroxime, cefotaxime, cefepime, ciprofloxacin, imipenem對ESBL-KP菌株的最低抑菌濃度;並利用脈衝式膠質電泳,進行菌株之分子流行病學之分析。研究結果顯示,此52株ESBL-KP對ampicillin, cephalothin, cefuroxime, cefotaxime, cefepime, ciprofloxacin, imipenem之MIC90(μg/mL)依次爲≥256, ≥256, ≥256, ≥256, 32, ≥32, 0.38μg/mL,此顯示即使是第四代頭孢芽菌素類抗生素,均不適合治療ESBL-KP所導致之感染;而ciprofloxacin僅對17株(32.7%)菌株有效,也突顯其臨床應用之局限性。至於imipenem,仍是對抗ESBL-KP最有效之抗生素。利用脈衝式膠質電泳進行分子流行病學研究之結果,顯示有7株屬於type A,怕株屬於type B,其餘35株,則屬於35個不同的脈衝式膠質電泳型式。此結果說明在此區域教學醫院內,可能已有兩個ESBL-KP菌株有水平菌株散播之現象,此現象是否會進一步惡化,值得後續追蹤。

並列摘要


The prevalence rate of extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) among all nosocomial clinical isolates of K. pneumoniae at a regional teaching hospital in Yun-Lin, Taiwan, were 25.0% and 24.1% in 2002 and 2003, respectively. These prevalence rates were higher than those reported from other hospitals. The following study was conducted to investigate the drug susceptibility of these isolates and whether there was a phenomenon of clonal spread among them. From October 2003 to May 2004, a total of 52 nosocomial clinical isolates of ESBL-KP collected at the regional teaching hospital was enrolled for further microbiologic study. Drug susceptibilities to ampicillin, cephalothin, cefuroxime, cefotaxime, cefepime, ciprofloxacin and imipenem were determined by minimum inhibitory concentration (MIC) using E-test, and the molecular epidemiology was determined by pulsed-field gel electrophoresis (PFGE). The results showed the MIC90 value of ampicillin, cephalothin, cefuroxime, and cefotaxime was >256μg/mL, that of cefepime and ciprofloxacin was > 32μg/mL, and that of imipenem was 0.38μg/mL. Ciprofloxacin was only effective for 17 strains (32.7%), therefore ciprofloxacin was not the best choice for treatment of ESBL-KP infection. Imipenem was still the most effective antibiotic to inhibit ESBL-KP. The molecular epidemiology showed that there were 7 strains belonging to type A, 10 strains to type B, and the remaining 35 strains to different minor PFGE types. Whether isolates belonging to type A or type B will lead to major clonal spread in the future should be closely followed.

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