- 學位論文
台北市都市汙水處理廠與某實驗農場環境水中大腸桿菌抗藥性之探討
Antimicrobial Resistance of Escherichia coli in Wastewater of Two Municipal Wastewater Plants and One Experimental Farm in Taipei City
若您是本文的作者，可授權文章由華藝線上圖書館中協助推廣。
摘要
背景 微生物對抗生素之抗藥性（antimicrobial resistance）在近年來成為全球公共衛生關注的重要議題之一，隨著世界衛生組織、聯合國糧食及農業組織和世界動物衞生組織提出整體防疫（One Health）的概念，近來研究開始探討潛在環境中與健康的人類與動物宿主的病原菌，其抗藥性隨宿主跨地域、跨國界傳播之機制，期望由整體環境的傳播途徑，減緩抗藥性的傳播。本研究選定台北市兩處汙水處理廠、一處實驗農場之畜牧區，依據場址中排放汙廢水之處理過程選定採樣點，選定自來水指標檢測之一大腸桿菌為標定細菌，檢測各採樣點水中大腸桿菌對不同分類抗生素之抗藥性比例與表現型之分布，目的為瞭解都市汙水處理設施與畜牧場兩類型場址水中大腸桿菌抗藥性特性，並討論其潛在之公共衛生危害，作為未來健康政策管制可參考之基礎。 材料及方法 採樣分別於108年3月11日、108年3月25日進行，並於採樣完畢立刻送至臺灣大學附設醫院感控中心實驗室冷藏，於同一日下午進行塗抹培養。各採樣點取兩瓶水樣，合計為汙水廠N = 12，畜牧場 N = 8。依序以chromIDTM Coli media區分性培養基、吲哚反應試驗確認、紙錠試驗篩選、VITEKTM 2 Compact System鑑定菌株。 結果 研究結果顯示，台北市汙水廠接收家戶及事業用水的入流水中，大腸桿菌除了對於第一線治療抗生素，如ampicillin-sulbactam、窄效性cephalosporins類（cefazolin、cefuroxime）、葉酸合成抑制類trimethoprim-sulfamethoxazole等具抗藥性之外，也對於後線治療之廣效性抗生素，如廣效性cephalosporin類與cephamycin類（ceftriaxone、ceftazidime、cefepime、cefmetazole、flomoxef等）與 quinolone (levofloxacin、ciprofloxacin) 具抗藥性。並發現了多重抗藥性菌株的存在，但尚未檢測到對廣效性後線抗生素carbapenem具抗藥性的菌株。具有ESBL抗藥性表型也佔了62.2%（迪化廠）與72.7%（內湖廠）。在畜牧場的結果顯示，畜牧場菌株主要對ampicillin-sulbactam、cephalosporin類、aminoglycoside類、trimethoprim-sulfamethoxazole等抗生素具抗藥性，除了整體相較汙水廠的抗藥性比例顯著較低，也未對cephamycin類、β-lactam合併β-lactamase抑制劑類、quinolone類、carbapenem類等較廣效性與後線的抗生素表現抗藥性；畜牧場菌株的野生型佔62%至78%，抗藥性表型主要為acquired penicillinase與high-level cephalosporinase (AmpC)併有ESBL的表型。
並列摘要
Background Microbial resistance to antibiotics has become one of the most important global public health concerns in recent years. Existing studies have explored the pathogens in the living environment of healthy human and animal hosts. Such resistance to medicines, and transmission of resistance in the environment, transcends regional or state borders. It is expected that the transmission of drug resistance will be slowed down by better antibiotic use and recognizing the overall geographical resistance transmission pathway. In this study, two wastewater treatment plants (WWTPs) in Taipei City and a livestock farm of National Taiwan University (NTU) were selected as sampling sites. According to the wastewater treatment process, ten sampling points were selected. Escherichia coli resistance prevalence and resistant phenotypes among these sampling points were identified. The purpose is to understand the characteristics of E. coli resistance in the waters of urban wastewater treatment facilities and livestock farms and to discuss its potential public health hazards, as a reference for future health policy. Material and Methods The sampling was carried out on March 11th and 25th, 2019. Samples were immediately sent to the laboratory of Center for Infection Control of Taiwan University Hospital for refrigeration. The enumeration and smear culture were carried out on the same day. Two samples of wastewater were taken at each sampling point, which totaled 12 grab samples for the two sewage plants and 8 grab samples for the livestock farm. The bacteria strains were identified by chromIDTM Coli media discriminating medium, Indole reaction assay confirmation, disk diffusion screening, and VITEKTM 2 Compact System. Results The results show that in the inflow water at the sewage treatment plant in Taipei City, which receiving households and business water, E. coli show resistance to the first-line treatment of antibiotics, such as ampicillin-sulbactam, narrow-acting cephalosporins (cefazolin, cefuroxime) and folate synthesis inhibitior trimethoprim-sulfamethoxazole, in addition to broad-acting antibiotic for post-line treatment, such as the broad-spectrum cephalosporin and cephamycin (ceftriaxone, ceftazidime, cefepime, cefmetazole, flomoxef, etc.) and quinolone (levofloxacin, ciprofloxacin). The presence of multi-drug resistant strains was also discovered, while no strains revealed resistance to last-line broad-spectrum antibiotic such as carbapenem (ertapenem and imipenem). The ESBL resistant phenotype also accounted for 62.2% (Dihua Plant) and 72.7% (Neihu Factory). The results in the livestock farm showed that the livestock farm strains were mainly resistant to first-line antibiotics such as ampicillin-sulbactam, cephalosporin, aminoglycoside, trimethoprim-sulfamethoxazole, etc., except that the prevalence of antimicrobial resistance was much lower than that of the sewage plants. Resistance to cephamycin, β-lactam combined β-lactamase inhibitors, quinolones, carbapenem and other broad-spectrum antibiotics were not detected; wild-type strains accounted for 62% to 78%, and the drug resistance phenotype was mainly acquired penicillinase and high-level cephalosporinase (AmpC) with an ESBL phenotype.
參考文獻
Sidjabat, H. E., & Paterson, D. L. (2015). Multidrug-resistant Escherichia coli in Asia: epidemiology and management. Expert Rev Anti Infect Ther, 13(5), 575-591. doi:10.1586/14787210.2015.1028365
國立臺灣大學環境工程學研究所，台灣水環境再生協會（民105）。下水道系統再生水利用技術參考手冊。經濟部水利署。取自 https://www.wra.gov.tw/media/22089/105年-下水道系統再生水利用技術參考手冊.pdf
行政院環境保護署《環境微生物檢測通則－細菌（NIEA E101.04C）》。https://www.epa.gov.tw/niea/BD1112FB7452F9A0。公告日105/08/17，實施日105/11/15。
行政院環境保護署《水中總菌落數檢測方法－塗抹法（NIEA E203.56B）》、《水中總菌落數檢測方法－濾膜法（NIEA E205.57B）》https://www.epa.gov.tw/niea/39D19479D3897831
Agga, G. E., Arthur, T. M., Durso, L. M., Harhay, D. M., & Schmidt, J. W. (2015). Antimicrobial-Resistant Bacterial Populations and Antimicrobial Resistance Genes Obtained from Environments Impacted by Livestock and Municipal Waste. PLOS ONE, 10(7), e0132586. doi:10.1371/journal.pone.0132586