廣泛抗藥鮑曼氏不動桿菌流行病學與抗藥性機轉之研究

鮑曼氏不動桿菌(Acinetobacter baumannii)是造成院內群突發感染之主要原因之一。近年來，由於抗生素廣泛使用，廣泛抗藥性鮑曼氏不動桿菌的問題日益受到重視。乙內醯胺類抗生素是現有的抗生素中使用最廣泛的一類，是屬於殺菌型的藥物，所以也最常產生抗藥性的一類藥物。我國區域級以上醫院監測資料顯示加護病房中鮑曼氏不動桿菌對carbapenem類抗生素具抗藥性之比例(carbapenem resistant A. baumannii, CRAB)已由2003年的17%增加至2013年的70%。抗微生物製劑抗藥性增加是一個全球性的問題，儘管各國所面臨的問題內容可能不盡相同。但如何透過監測與資料回饋、抗生素使用管制、或隔離防護等適當的感染控制措施等方式，有效遏止抗微生物製劑抗藥性問題的持續惡化，是全世界共通需要面對的重要課題。本研究自2012年3月13日到2013年12月31日在新北市某部立醫院共收集了184株不重覆，並且符合收案定義的廣泛抗藥性不動桿菌(Extensively drug-resistant Acinetobacter；XDRA)菌株，就性別而言：男性136位，女性48位。年齡層從30歲到97歲。這些XDRA菌株包括164株(89％) 鮑曼氏不動桿菌(A. baumanii；AB)與20株(11％)非鮑曼氏不動桿菌（Non-A. baumannii；Non-AB），以加護病房佔最多數(35.9％)。藉由抗藥性基因型的分析，XDRAB均帶有blaOXA-51-like，這種基因是公認的被內在位於鮑曼氏不動桿菌菌株；有101株除了帶有blaOXA-51-like之外還帶有blaOXA-23-like (61.6%)，有43株帶有blaOXA-51-like與blaOXA-24-like基因(26.2%)，8株帶有blaOXA-51-like，blaOXA-23-like以及blaOXA-24-like (4.9%)，2株帶有blaOXA-51-like，blaOXA-23-like以及blaOXA-58-like (1.2%)。至於XDR non-AB中有1株帶有blaOXA-24-like (5.0%)，有3株帶有blaOXA-58-like基因(15.0%)，1株帶有blaOXA-23-like以及blaOXA-58-like (5.0%)，2株帶有blaOXA-24-like以及blaOXA-58-like (10.0%)。這些XDRAB菌株所帶有的blaOXA-24-like經確定為blaOXA-72，此型常常與碳青黴烯高抗藥性有相關。本研究提供了關於XDRA的類型和流行率的最新數據，同時我們也提出帶有blaOXA-24-like基因的XDRA在台灣北部出現與傳播的警訊。

關鍵字

多重抗藥性鮑曼氏不動桿菌；廣泛抗藥性鮑曼氏不動桿菌；泛抗藥性鮑曼氏不動桿菌

並列摘要

Acinetobacter baumannii is an important nosocomial pathogen. In recent years, the problem of extensively drug-resistant A. baumannii increases attention duing to the widespread use of antibiotics. -lactam antibiotic is part of bactericidal drugs. It is also the most common occurrence of resistance. An annual increase in the proportion of the carbapenem resistant A. baumannii in Taiwan from 17% in 2003 to 70% in 2013 was documented by the Taiwan Nosocomial Infection Surveillance (TNIS) System. But how to effectively curb the continued deterioration of the antimicrobial resistance problem through through monitoring and information feedback, control of antibiotic usage, and appropriate infection control measures, etc., is an important issue around the world. In this study, we identified and collected 184 extensively drug-resistant Acinetobacter isolates from a regional hospital in New Taipei City from Mar. 13, 2012 to Dec. 31, 2013. There are 136 male and 48 female, ages from 30 years old to 97 years old. Among the 184 non-repetitive isolates of the XDRA, there are 164 (89%) Acinetobacter baumannii (AB), and 20 (11%) non- Acinetobacter baumannii (non-AB). These isolates originated mainly from intensive care unit patients (35.9%). Among the XDRAB isolates, all harbored the blaOXA-51-like gene. This gene is well known to be intrinsically located in A. baumannii isolates. Other CHDL-encoding genes were detected. The blaOXA-23-like gene, which was the most common 61.6% (101/164), followed by a lower occurrence of the blaOXA-24-like gene26.2% (43/164); 4.9% (8/164) possessing both the blaOXA-23-like gene and the blaOXA-24-like gene; and 1.2% (2/164) harboring both the blaOXA-23-like gene and the blaOXA-58-like gene. Of the XDR non-AB isolates, the blaOXA-24-like gene accounted for 5.0% (1/20); 15.0% (3/20) possessing the blaOXA-58-like gene; 5.0% (1/20) possessing both the blaOXA-23-like gene and the blaOXA-58-like gene; and 10.0% (2/20) possessing both the blaOXA-24-like gene and the blaOXA-58-like gene. The XDRAB isolates had an acquired blaOXA-24-like gene which was confirmed by sequencing for the encoded blaOXA-72 carbapenemase and were often associated with high-level carbapenem resistance. This study provides updated data on the types and prevalence of XDRA. In addition, it presents a warning on the emergence and spread of XDRA-harboring blaOXA-24-like genes in Northern Taiwan.

並列關鍵字

blaOXA-24/40-like:blaOXA-72 ； ST512 ； Multidrug-resistant(MDR) ； extensively drug-resistant（XDR）； pandrug-resistant bacteria（PDR）

參考文獻

66. Anke K., et al.,Outbreak of carbapenem-resistant Acinetobacter baumannii

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廣泛抗藥鮑曼氏不動桿菌流行病學與抗藥性機轉之研究

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