某醫學中心Acinetobacter calcoaceticus-Acinetobacter baumannii complex院內菌血症菌株之分子流行病學分析

A Molecular Epidemiological Analysis on the Nosocomical Bacteremia Strain Acinetobacter Calcoaceticus-Acinetobacter Baumannii Complex in a Medical Center

彭銘業(Ming-Yieh Peng) ； 詹明錦(Ming-Chin Chan) ； 張峰義(Feng-Yee Chang)

《內科學誌》 19卷6期 (2008/12) Pp. 516-522

https://doi.org/10.6314/JIMT.2008.19(6).09

摘要

Acinetobacter calcoaceticus-Acinetobacter baumannii complex（簡稱Ac-Ab complex）爲革蘭氏陰性桿菌，造成的感染日益增加，近年來漸漸成爲重要的院內致病菌。由於其天然的多重抗藥特性，對其他抗生素極容易產生抗藥性，故逐漸成爲院內感染的主要菌株，爲瞭解Ac-Ab complex菌株於本院院內血流感染之分子生物流行病學，以建立本院Ac-Ab complex院內血流感染資料庫，作爲Ac-Ab complex爆發流行或群聚感染調查工具，而增加對Ac-Ab complex流行病學的研究將有助於防止Ac-Ab complex之擴散，依據美國CDC定義收集2005-2006年院內Ac-Ab complex血流感染菌株進行脈衝電泳分型法(Pulsed-Field Gel Electrophoresis Analysis)，資料顯示所收集49株院內血流Ac-Ab complex感染其分子分型並不相同，也並未有明顯關聯性，由此可見某醫學中心院內血流Ac-Ab complex感染並無群聚情形發生或優勢菌株存在，探討原因應與醫護人員落實執行感染管制措施及抗生素使用管制的執行有關，本院洗手設置的便利性及數量可謂充分，而感控人員持續在職教育及稽核等因素亦有關，在抗生素敏感性試驗方面可以發現Ac-Ab complex院內血流感染對抗生素ampicillin、cephalothin、ceftriaxone、flomoxef皆呈抗藥性，但對ceftazidime、cefepime、gentamicin、amikacin、ciprofloxacin及trimethoprim-sulfamethoxazole之抗藥性大於四成以上，對於用來治療院內感染Ac-Ab complex最後一線藥物imipenem抗藥性則爲6.1%。

關鍵字

Acinetobacter calcoaceticus-Acinetobacter baumannii complex院內感染 ； 脈衝電泳分型法 ； 抗生素敏感性試驗 ； Imipenem

並列摘要

Acinetobacter calcoaceticus-Acinetobacter baumannii complex (Ac-Ab complex) is a gram-negative bacilli that causes increasing numbers of infections; in recent years it has become an important nosocomial pathogen. Its intrinsic multi-drug resistance makes enables the fast development of resistance against other antibiotics. Therefore, it has gradually become the main strain for nosocomial infections. In order to understand the molecular epidemiology of Ac-Ab complex strain that causes nosocomial bacteremia infection in the selected hospital, an Ac-Ab complex nosocomial haemapoetic infection database was established; the database may be used as reference in investigating the epidemic outbreaks or group infections of Ac-Ab complex. Increased studies on Ac-Ab complex epidemiology will help prevent the prevelanc of Ac-Ab complex. Based on the nosocomial definition of CDC (USA), nosocomial Ac-Ab complex hemapoetic infection strains were collected during the period of 2005-2006 for pulsed-field gel electrophoresis analyses (PFGE). Data showed that the 49 Ac-Ab complex strains collected that can cause nosocomial bacteremia infection are different in PFGE patterns, and no significant correlation was detected among them, suggesting that the Ac-Ab complex bacteremia found in the medical center did not result in clustered infection and there was no dominant strain. It is believed that the cause was related to the execution of infection control policies and the antibiotic controll. The hand washing facilities in the hospital were convenient and sufficient in quantity; additionally, the continuous education and assessment for infection control were also related to the infection events. On the aspect of antibiotics susceptibility tests, it was found that Ac-Ab complex collected from nosocomial bacteremia infection was resistant to ampicillin, cephalothin, ceftriaxone, and flomoxef; however, the bacterial resistance to ceftazidime, cefepime, gentamicin, amikacin, ciprofloxacin and trimethoprim-sulfamethoxazole was greater than 40%. Regarding the last-resort treatment of nosocomial Ac-Ab complex infection, imipenem, the resistance found was 6.1%.

並列關鍵字

Pulsed-field gel electrophoresis analysis ； Imipenem