- 期刊
台灣東部及北部之產超廣效性乙醯胺酶（ESBLs）肺炎克雷伯氏菌（Klebsiella pneumoniae）的藥敏型式比較
Antimicrobial Susceptibility Patterns of ＂Klebsiella pneuminiae＂-ESBLs Isolated from Hospitals in Eastern and Northern Taiwan
摘要
抗生素不當的使用導致近年來抗藥性細菌出現比例增加。克雷伯氏桿菌屬（Klebsiella spp.）為一種伺機性感染的病原細菌，因為超廣效性乙醯胺酶（Extended-spectrum -lactamases, ESBLs）的抗藥性菌株的產生而增加了治療上的困難。本研究依據2011年美國Clinical and Laboratory Standards Institute （CLSI）M07-A8和M02-A10的瓊脂平板稀釋法（agar dilution methods）和紙錠擴散法（disc diffusion methods）及其判讀標準M100-S21，分析2008~2011 年台灣區域東部以及北部的醫療院所中篩選到的Klebsiella pneumoniae-non ESBLs與ESBLs菌株對現行醫療上常用藥物的藥敏型式，結果顯示，（i）Imipenem（IPM）為目前對抗K. pneumoniaenonESBLs及K. pneumoniae-ESBLs菌株最有效之抗生素，amikacin則次之；（ii）大多數K. pneumoniae-nonESBLs 和K. pneumoniae-ESBLs 菌株對測試的抗生素逐漸產生更高的抗藥性。吾等也從台灣地區其他研究中發現因為地域的區隔，K. pneumoniae-ESBLs菌株在不同區域會對其他常用藥物發展出不同藥敏型式。另外，比較前人研究與本研究的結果發現此菌株對amikacin在近年中抗藥性比例比十年前有顯著的增加，因此在臨床上必須依據實檢室測試結果慎選治療藥物，以及監控個別醫院抗生素使用情形。
並列摘要
Klebsiella spp. is an opportunistic infectious pathogen that causes pneumonia, bacteremia, meningitis, and urinary tract infection et al. Widespread use of -lactam antibiotics generate the increasing of antimicrobial bacterium. The increasing of extended-spectrum-lactamases (Extended-spectrum-lactamases, ESBLs) Klebsiella pneumoniae make the clinical drug therapy much more difficult. In order to understand the variation of antimicrobial susceptibility in the K. pneumoniae-non ESBLs and ESBLs isolates from eastern Taiwan and nothern Taiwan, we collected the bacteria isolated strains from 2008 to 2011 for this study. The antimicrobial susceptibility test was followed the guidance of CLSI standard M07-A8, M02-A10 and M100-S21 (2011). Data revealed that: (1) Imipenem was the most efficient antimicrobial to treat K. pneumoniae-non ESBLs and ESBLs infection in these days. Amikacin was the next. (2) The test strains had higher values in the minimal inhibitory concentrations for 90% of the test antimicrobial agents. Compared with other studies, the antimicrobial susceptibility panels of K. pneumoniae-ESBLs were different from region to region and the resistance ratio of amikacin was significant increased in the past 10 years. In conclusion, the use of therapeutic drugs must be relied on correct laboratory susceptibility test. The usage of antimicrobial agent in hospitals should be monitored and controlled.