某醫學中心醫療照護相關感染ESBL-producing Klebsiella pneumoniae菌株之分子流行病學分析

A Molecular Epidemiology Analysis on Healthcare-associated Infection Extended-spectrum β-lactamases Producing Klebsiella Pneumoniae in a Medical Center

詹明錦(Ming-Chin Chan) ； 張靜美(Ching-Mei Chang) ； 邱玉惠(Yu-Hui Chiu) ； 黃子鳳(Tzu-Feng Huang) ； 王甯祺(Ning-Chi Wang) ； 林永崇(Jung-Chung Lin)

《內科學誌》 23卷3期 (2012/06) Pp. 206-214

https://doi.org/10.6314/JIMT.2012.23(3).08

摘要

廣效性乙內醯胺酶（extended-spectrum β-lactamases; ESBLs）在1980年代被初次發現以後，很快地遍佈到世界各地，可造成廣泛的cephalosporins與aztreonam類抗生素抗藥性的形成，常見於Escherichia coli及Klebsiella pneumoniae等腸道菌，並可造成廣泛的cephalosporins與aztreonam類抗生素抗藥性的形成，根據不同地區發表的文獻得知，一種ESBL不只局限在同一地區，可藉由宿主的四處移動而散佈至不同地區及國家。本研究依據某醫學中心專任感染管制護理師以美國疾病管制中心公佈之醫療照護相關感染定義進行全院性監測，收集2007年1月至2008年6月符合醫療照護相關ESBL-producing K. pneumoniae感染定義者相關資料統整及分析菌株分子分型，研究結果顯示醫療照護相關ESBL-producing K. pneumoniae感染部位以泌尿道感染59.5%最多，而病房分佈則以一般病房78.6%較加護病房11.4%高出6至7倍，在抗生素敏感試驗方面可以發現醫療照護相關感染ESBL-producing K. pneumoniae除了對imipenem與ertapenem之感受性分別為100%及94.6%外，對其餘抗生素抗藥性均超過六成以上，以脈衝式電泳（pulsed field gel electrophoresis, PFGE）進行分析結果並無群聚感染情形發生或優勢菌株存在。對於治療醫療照護相關ESBL-producing K. pneumoniae感染之藥物仍以carbapenem類藥物敏感性測試最佳。

關鍵字

廣效性乙內醯胺酶 ； 醫療照護相關感染 ； 脈衝式電泳 ； 克雷伯氏肺炎菌

並列摘要

Eextended-spectrum β-lactamases (ESBLs) was first found in 1980's, and they spread to worldwide very soon. ESBLs generally distributed in Enterobacteriaceae such as Escherichia coli and Klebsiella pneumoniae, contributed to the resistance of cephalosporins and aztreonam. From publications in the English literature, ESBLs spreaded to different regions or countries via the traveling host. This study was focused on the definition of ESBL-producing K. pneumoniae related healthcare-associated infections, executed the hospital-wide surveillance, data analysis, and assay the bacteria genotype from Jan 2007 to June 2008. Results showed the highest incidence of ESBL-producing K. pneumoniae related healthcare-associated infections was UTI (59.5%). Infection rate in general ward was 78.6% as higher as 6~7 folds than intensive care unit 11.4%. From antibiotic susceptibility test, sensitive of imipenem and ertapenem for ESBL-producing K. pneumoniae were 100% and 94.6% respectively and resistance to other antibiotics were over 60%. Result of pulse-field gel electrophoresis showed there was not outbreak or existence of dominant strain during the surveillance. Our study demonstrated that carbapenem was still the best choice for treatment of ESBL-producing K. pneumoniae infections.

並列關鍵字

Extended-spectrum β-lactamases ； Healthcare-associated infection ； Pulsed field gel electrophoresis ； Klebsiella pneumoniae