- 期刊
抗萬古黴素屎腸球菌的分子流行病學
Molecular Epidemiology of Vancomycin-Resistant Enterococcus Faecium
摘要
目的：抗萬古黴素屎腸球菌（VRE-fm）的分離率逐年上升，已成為臨床重要的致病菌之一，需重視其造成的感染危機。本研究主要探討VRE-fm在台北市五間區域教學醫院的流行病學發展的趨勢。方法：本研究收集五間醫院共100株VRE-fm以抗生素敏感性試驗、重複元件回文聚合酶反應（rep-PCR）和多位點序列分型（MLST）進行基因分型。以聚合酶連鎖反應（PCR）分析VanA抗藥基因，進行比對分析。結果：研究發現VRE-fm以尿液檢體（80%）最多，除了Doxycycline（32%抗藥性）、Linezolid（4%抗藥性）、Quinupristin-dalfopristin（18%抗藥性）及Daptomycin（0%抗藥性）這四種藥物，其對大多數抗生素有具有高度抗藥性。VRE-fm全部攜帶VanA抗藥基因，基因分型顯示，有三種主要的序列分型（ST）類型（ST17，ST78和ST262），其中以ST17占最多的比例。以ST type與抗藥性間的關聯進行分析，發現ST78對於Quinupristin-dalfopristin的抗藥性（48%）及ST262對於Gentamicin-Synergy藥物的抗藥性（80%）比其他兩個型別還要高。結論：VRE-fm的連續傳播和定殖易造成疾病爆發，需要持續監測與適當的感染控制策略，並做好相關的預防措施，以提升醫療照護品質。
並列摘要
Objective: The isolation rate Vancomycin-resistant Enterococcus faecium (VRE-fm) is increasing year after year and has become one of the important disease causing bacteria, and thus, the risk of infection is of concerned. This study aimed to investigate the molecular epidemiology of VER-fm in five regional teaching hospitals in the Taipei city. Methods: One hundred VRE-fm isolates were collected from the five hospitals. Antimicrobial susceptibility tests were performed. Genotyping was performed using repetitive element palindromic-polymerase chain reaction (rep-PCR) and multilocus sequence typing (MLST). The VanA drug resistant gene was analyzed by polymerase chain reaction (PCR). Result: The highest isolation rate of VREfm was found in the urine samples (80%). Except for Doxycycline (32%R), Linezolid (4%R), Quinupristin-dalfopristin (18%R), and Daptomycin(0%R), VRE-fm isolates were highly resistant to most of the tested antibiotics. All VRE-fm isolates carried the Van A drug resistant gene. The genotyping data indicated three prevailing major ST types (ST17, ST78, and ST262), which were disseminated across the five regional hospitals. Conclusion: The continuous transmission and colonization of VRE-fm are prone to disease outbreaks. Monitoring of VRE-fm together with proper infection control strategy are essential to improve healthcare quality.
延伸閱讀
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- 詹明錦、許松等、林永崇、方啟泰（2021）。台北某醫院醫療照護相關萬古黴素抗藥性屎腸球菌感染之分子流行病學分析。感染控制雜誌，31(5)，216-230。https://doi.org/10.6526/ICJ.202110_31(5).0002
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