- 學位論文
抗甲氧本青黴素金黃色葡萄球菌在急診病人及醫療照護者的鼻腔帶菌率和分子特性分析
Nasal Carriage Rate and Molecular Characterization of Methicillin-Resistant Staphylococcus aureus among Patients Visiting Emergency Department and Healthcare Workers
摘要
研究背景及目的：醫院中抗甲氧本青黴素金黃色葡萄球菌帶菌率的篩檢和鑑定分析，有助於控制其在醫院的傳播。我們研究的目的是去分析抗甲氧本青黴素金黃色葡萄球菌在台灣兩家區域醫院的患者和醫療照護人員中，鼻腔帶菌的盛行率和菌種的多樣性。 研究方法：本前瞻性研究於2015年2月至2015年6月共5個月期間，在台灣彰化縣2家區域醫院共204位急診的就診患者和326位醫院的醫療照護者做鼻腔的採檢。所有培養分離出來的抗甲氧本青黴素金黃色葡萄球菌，做進一步的分子生物鑑定。 研究結果：在204位急診患者中，金黃色葡萄球菌和抗甲氧本青黴素金黃色葡萄球菌的鼻腔帶菌率分別為22.1％和7.8％。在326位醫療照護者中，金黃色葡萄球菌和抗甲氧本青黴素金黃色葡萄球菌的鼻腔帶菌率分別為26.1％和6.1％。其中抗甲氧本青黴素金黃色葡萄球菌的鼻腔帶菌率在急診患者和醫療照護者之間並無統計學意義（P= 0.447）。我們發現在急診患者中有接受血液透析的病人與抗甲氧本青黴素金黃色葡萄球菌的鼻腔帶菌率有顯著的統計相關性（P=0.012）。對於所有分離出的36株抗甲氧本青黴素金黃色葡萄球菌，前三名序列型（ST）依次為ST59（16株，44.4％），ST45（11株，30.6％）和ST239（3株，8.3％）。醫療照護者中的主要菌株（佔30％）為 ST59/SCCmec IV/t437/PVL-negative。急診患者中的主要菌株（佔19％）為ST45/SCCmec V/t1081/PVL-negative。 結論與建議：總體而言，本研究中在鼻腔移生的抗甲氧本青黴素金黃色葡萄球菌大部分屬於社區型的菌株，最主要的菌株為ST59。而值得注意的是，抗甲氧本青黴素金黃色葡萄球菌的ST45菌株取代了ST239作為第二多的鼻腔帶菌株。
並列摘要
Background and Objective：Screening and identification of Methicillin-resistant Staphylococcus aureus (MRSA) carriage is helpful for controlling MRSA spread in hospitals. The aim of our study was to determine the prevalence of nasal carriages and diversity of MRSA among patients and healthcare workers (HCWs) at two regional hospitals in Taiwan. Methods: Nasal swabs were obtained prospectively from 204 patients visiting Emergency Department (ED) and 326 HCWs in 2 regional hospitals in Changhua, Taiwan between February 2015 and June 2015. All the MRSA isolates were further characterized molecularly. Results: Of the 204 participating patients, 22.1% and 7.8% patients were colonized by S. aureus and MRSA, respectively. For HCWs, the S. aureus and MRSA carriage rate was 26.1% and 6.1%, respectively. There was no statistically significance of MRSA carriage rate between patients and HCWs (P=0.447). Patients receiving hemodialysis were significantly associated with MRSA colonization (P=0.012). For all 36 MRSA isolates, the leading three sequence type (ST) in order was ST59 (16, 44.4%), ST45 (11, 30.6%) and ST239 (3, 8.3%). ST59/SCCmec IV/t437/ PVL-negative was the predominant clone amongst HCWs (30%), and ST45/SCCmec V/t1081/PVL-negative was the predominant clone amongst participating patients (19%). Conclusion: Overall, a substantial proportion of patients visiting ED and HCWs harbored CA-MRSA in their nares, mostly ST59 strains. It is noteworthy that MRSA ST45 strains supplanted ST239 as the second leading nasal MRSA colonization strain in our study.
參考文獻
延伸閱讀
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