北部某區域教學醫院金黃色葡萄球菌藥敏型式的統整分析

Integration Analysis of Antimicrobial Susceptibility of Staphylococcus aureus in a Regional Teaching Hospital Located in Northern Taiwan

黃韶顏(Shau-Yen Huang) ； 呂汶紋(Wen-Wen Lu) ； 呂昀儒(Yun-Ju Lu) ； 施勇綸(Yung-Luen Shih) ； 陳媛孃(Yung-Liang Chen) ； 翟恆煒(Herng-Woei Jair) ； 呂旭峰(Hsu-Feng Lu) ； 陳兆平(Chao-Ping Chen) ； 劉嘉又(Jia-You Liu)

《檢驗及品保雜誌》 6卷1期 (2017/03) Pp. 24-31

https://doi.org/10.6573/JTQA.201703_6(1).04

摘要

金黃色葡萄球菌(Staphylococcus aureus)常造成院內感染與社區感染，由於細菌抗藥性日趨嚴重，其治療藥物的選擇更需謹慎，且治療劑量、途徑及療程亦顯複雜。自從2002年美國密西根州首先分離出9株萬古黴素抗性的VRSA(vancomycin-resistant S. aureus)之後，高抗藥性之金黃色葡萄球菌已成為公共衛生首需重視的焦點。本研究收集台北市某區域醫院臨床金黃色葡萄球菌分離株123株，以自動化Vitek 2系統執行抑菌濃度(inhibitory concentration, IC)監控，結果指出此菌對易被盤尼西林酶破壞之盤尼西林(benzylpenicillin)與對盤尼西林酶穩定之苯唑西林(oxacillin)的感受性比率分別為6%與68%。其中，本研究發現一株對萬古黴素(vancomycin)具中間型抵抗性的金黃色葡萄球菌，MIC為4 g/mL。此菌對其它常用治療藥物的感受性比率，以替考拉寧(teicoplanin)、利奈唑酮(linezdid)與替加環素(tigecycline)三者最高，皆為100%，其次為萬古黴素(99%)，緊接著是利福平(rifampicin, 98%)與達托黴素(daptomycin, 97%)。另外，此菌對氯黴素(chloramphenicol, 88%)的感受性比率排名第七位，而對甲氧芐啶/磺胺甲噁唑(trimethoprim/sulfamethoxazole, 84%)則排名第八位。感受性稍差的藥物為克林黴素(clindamycin, 67%)與紅黴素(erythromycin, 54%)。鑒於上述的發現，吾等建議醫院必須常規監控病患的各種感染、各種臨床分離株的藥敏型式以及執行嚴格的院內、外抗微生物劑使用政策，將是當前預防高抗藥性或多重抗藥性的最重要課題。

關鍵字

金黃色葡萄球菌 ； 院內感染 ； 社區感染 ； 最低抑菌濃度

並列摘要

Staphylococcus aureus is one of the most common causes of hospital- and community-acquired infections, and treatment infections is complicated by the ability of this kind of bacteria to become resistant to antibiotics. Since 2002, nine methicillin-resistant S. aureus (MRSA) strains that are also resistant to vancomycin (VRSA) have been reported from Michigan in the United States. Acquisition of high-level vancomycin resistance by S. aureus strains already multiresistant to antibiotics is a major public health problem. By the MIC evaluation, we aimed to screen and assess the antimicrobial susceptibility pattern of S. aureus isolated from clinical specimens in a regional teaching hospital of Taipei city in Taiwan. We performed 123 strains of S. aureus to evaluate the inhibitory concentrations (IC) of various antimicrobial agents by the automated Vitek 2 system. The results indicated that the susceptibility rates to pencillinase-labile pencillin (benzylpencillin) or pencillinase-stable pencillin (oxacillin) were 6% or 68%, individually. In this study, we also islated one GISA strain with MIC=4 g/mL. About susceptibility rates, the top went to teicoplanin (100%), linezolid (100%) and tigecycline (100%), followed by vancomycin (99%), rifampicin (98%) and daptomycin (97%). Except benzylpenicillin, the susceptible rate of chloramphenicol (88%) to S. aureus kept its number seven ranking and followed by trimethoprim/ sulfamethoxazole (SXT ) (84%). The less susceptible antimicrobial agents were clindamycin (67%) and erythromycin (54%). We recommend regular surveillance of hospital associated infections, monitoring antibiotic sensitivity pattern and strict drug policy for antimicrobial agents used within and outside the hospital has never much more demanded in the present days.

並列關鍵字

Staphylococcus aureus ； hospital-acquired infections ； community-acquired infections ； minimum inhibition concentration