四家長庚醫院加護病房中會產生超廣效性乙醯胺酶的Klebsiella pneumoniae及Escherichia coli之分子流行病學探討

Molecular Epidemiology of Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae and Escherichia coli in Intensive Care Units of Four Chang Gung Memorial Hospitals

李佳縉(Chia-Chin Li) ； 賈儒馨(Ju-Hsin Chia) ； 郭安靜(An-Jing Kuo) ； 簡春治(Chun-Chih Chien) ； 黃淑鍰(Shu-Yuan Huang) ； 莊慧如(Hui-Ju Chuang) ； 吳竹蘭(Tsu-Lan Wu) ； 蘇玲慧(Lin-Hui Su)

《Journal of Biomedical & Laboratory Sciences》 23卷2期 (2011/06) Pp. 62-69

https://doi.org/10.30046/JBLS.201106.0004

摘要

會產生超廣效性乙醯胺酶(extended-spectrum β-lactamase, ESBL)之腸內菌，在全世界均造成嚴重之抗藥性問題。在台灣，會產生ESBL的Klebsiella pneumoniae及Escherichia coli之盛行率均高於歐美國家。依據長庚紀念醫院四院區統計2001-2004年之相關資料顯示，加護病房中此兩種細菌又比一般病房有著更高之盛行率。爲了瞭解各種ESBL的實際流行情形與是否有地區性的差異存在，因此本研究收集南北四家長庚醫院在2005年1月至6月之間，從加護病房分離之K. pneumoniae 130株及E. coli 143株，分別進行ESBL型別及菌株基因型之研究。分析結果顯示，ESBL型別以SHV及CTX-M兩類爲主，而後者又佔有較高比例(80.9%)，其中以CTX-M-14 (39%)最多，其次爲CTX-M-3 (20%)及SHV-12 (14%)。若以不同細菌分別分析，K. pneumoniae具有14種ESBL型別（9種SHV及5種CTX-M），遠多於E. coli之ESBL型別（2種SHV及6種CTX-M）。南北院區之ESBL型別亦略有不同：對於K. pneumoniae而言，在林口及基隆院區CTX-M有較高之盛行率(75%)，而高雄院區卻以SHV有較高之比率(60%)；至於E. coli方面，南北院區均以CTX-M爲最多（87.5%-100%，平均93.7%）。另從菌株基因型分析，會產生ESBL的K. pneumoniae及E. coli分別鑑定出75種及115種基因型，顯示兩種菌株均具有高度差異之基因型，但仍可發現一些基因型小群聚的現象。此次研究結果顯示，南北台灣分離的ESBL菌株，不論就其ESBL型別或菌株基因型分析，均有明顯的差異，顯然大型跨區域之研究是有其持續追蹤之必要性。

關鍵字

ESBL ； Klebsiella pneumoniae ； Escherichia coli ； SHV ； CTX-M ； 加護病房

並列摘要

Objective: Members of the Enterobacteriaceae that were able to produce extended-spectrum β-lactamases (ESBLs) have aroused global concerns regarding their multiple drug resistance. In Taiwan, the prevalence rates of ESBL-producing Klebsiella pneumoniae and Escherichia coli were relatively higher than those from other countries in Europe and American. During 2001-2004, analysis of the isolation rates of these resistant bacteria from four Chang Gung Memorial Hospitals (CGMHs) revealed that the prevalence rates of such resistant pathogens were much higher among intensive care units (ICUs) than those among general wards. To further elucidate the extent and mode of dissemination of these ESBL-producing isolates, a total of 130 K. pneumoniae and 143 E. coli isolates were collected from ICUs between January and June 2005. The genetic relatedness of these isolates and the genotypes of the ESBLs were investigated. The results revealed that SHV-and CTX-M-type ESBLs were the two major ESBL types with CTX-M-type ESBLs (80.9%) being the most prevalent. Among them, the most common ESBLs were CTX-M-14 (39%), CTX-M-3 (20%), and SHV-12 (14%). ESBL types were more diverse in K. pneumoniae than in E. coli. A total of 14 ESBL types (9 SHVs and 5 CTX-Ms) were found in K. pneumoniae, while 8 ESBLs (2 SHVs and 6 CTX-Ms) were found in E. coli. In K. pneumoniae, the prevalence rate of CTX-M-type ESBLs (both 75%) was higher than that of SHV-type ESBLs in northern CGMHs, while in southern CGMH (Kaohsiung), the prevalence rate of SHV-type ESBLs (60%) was higher than that of CTX-M-type ESBLs. In E. coli, CTX-M-type ESBLs were the most prevalent among all CGMHs (87.5%-100%, average 93.7%). Molecular typing analysis demonstrated 75 genotypes in K. pneumoninae and 115 genotypes in E. coli, suggesting the high genetic diversity in both organisms. However, small clusters of genotypes were also noted. In summary, ESBL-producing bacteria differed in both genotypes and prevalence rates between the two ends of Taiwan. Continuous surveillance of the prevalence and changing epidemiology among the ESBL-producing populations appears necessary.

並列關鍵字

ESBL ； Klebsiella pneumoniae ； Escherichia coli ； SHV ； CTX-M ； ICUs