呼吸照護病房腸內菌屬產生廣效性乙內醯胺酶之危險因子與其CTX-M基因型分佈

Risk Factors and CTX-M Genotype Distribution of Esbl-Producing Enterobacteriaceae in Respiratory Care Wards

賴力安(Li-An Lai)

指導教授 ： 薛玉梅

臺北醫學大學/公共衛生暨營養學院/公共衛生學研究所/碩士(2009年)

https://doi.org/10.6831/TMU.2009.00128

摘要

本研究為探討呼吸照護病房與病人感染帶廣效性乙內醯胺酶細菌之相關危險因子及其CTX-M基因型之分布情形。以病例對照研究進行比較感染帶有廣效性乙內醯胺酶細菌的病人與感染不帶廣效性乙內醯胺酶細菌病人、感染帶有廣效性乙內醯胺酶細菌的病人與沒有細菌感染病人，分析影響感染帶廣效性乙內醯胺酶細菌的著危險因子。研究地點選定台北縣板橋市中英醫院附設以及台北縣新店市同仁醫院附設之呼吸照護病房。經醫師判定為疑似尿道感染病人，收集其尿液，並記錄病人基本人口學、慢性病史、使用抗生素情形等資料。利用SAS 9.0套裝軟體進行重複量數的統計分析危險因子。萃取細菌DNA後利用聚合酶連鎖反應將細菌特定的DNA片段增幅，定序比對標準序列判定基因型。
結果發現在校正年齡、性別與住院天數後同時使用兩種抗生素者感染帶有廣效性乙內醯胺酶細菌的危險對比值為3.87，95%信賴區間1.36 - 10.99。在校正年齡、性別與住院天數，使用頭孢子素（cephalorsporins）者顯著感染帶有廣效性乙內醯胺酶的危險對比值為3.76，95%信賴區間1.14-12.35。使用賽洛普類（ciprofloxacin）抗生素者顯著感染帶有廣效性乙內醯胺酶的危險對比值為5.63，95%信賴區間1.08 - 29.21。舒張壓每增加一mmHg危險對比值為1.03，95%信賴區間1.00 - 1.06。校正性別與住院天數後，年齡每增加一歲感染帶乙內醯胺酶克雷白氏肺炎桿菌的危險對比值為1.03，95%信賴區間1.01 - 1.05、使用美羅陪南（meropenem）抗生素者感染帶乙內醯胺酶克雷白氏肺炎桿菌的危險對比值為0.03，95%信賴區間0.00 - 0.35。
本次研究中呼吸照護病房所收集的尿液培養細菌，其中帶有廣效性乙內醯胺酶之CTX-M基因型分佈均為CTX-M-1基因型。其中又以CTX-M-3基因型為多，佔95%，CTX-M-15佔2%，另有一疑似突變之CTX-M基因型。

關鍵字

廣效性乙內醯胺酶CTX-M基因型 ； 抗生素 ； 頭孢子素 ； 呼吸照護病

並列摘要

The objective of this study is to explore risk factors that related to patients who infected ESBL-producing bacteria and the distribution of CTX-M genotype of ESBL in respiratory care wards (RCW). A case control study was conducted to compare the risk factors of ESBL-producing bacteria between ESBL groups and non-ESBL groups or between ESBL groups and no infection group respectively. Study participants were recruited from Tunjen hospital RCW and Choninn hospital RCW in Xindian city and Banqiao city of Taipei county. Urine and germiculture samples were collected from patients who got fever and were diagnosed to be suspectable urologic tract infection by phsicians. Information including basic sociodemographic characteristics, diseases status and antibiotic use of patients were also collected. SAS software was used to analyze risk factors by repeated measurment program. Bacteria genomic DNA was extracted to do polymerase chain reaction to amplify specific DNA and then to assess coden sequence. Initrogen software was used to transfer coden sequence into amino acid sequence and then compared with NCBI standard sequence to identify the genotype.
After adjustment for gender, age and length of hospital stay, the OR of ESBL for whom used cephalosporins at least 30 days was 3.76, 95% CI 1.14 - 12.35 compared with non-user. Participants who consumed ciprofloxacin at least 30 days the OR of ESBL was 5.63, 95% CI, 1.08 - 29.21 compared with non-user. Participants who consumed more than two kinds of antibiotic at the same time at least 30 days the OR of ESBL was 3.87, 95% CI, 1.36 - 10.99 compared with non-user. The OR of ESBL was 0.03, 95%CI, 0.60 - 0.35 for participants who consumed meropenem at least 30 days compared with non-user. The older age was the higher OR of ESBL (OR 1.03, 95% CI, 1.01 - 1.05), The higher DBP was the higher OR of ESBL (OR, 1.03, 95% CI, 1.00 - 1.06).
In this study, CTX-M genotype of all ESBL producing bactreia were belong to CTX-M-1 group which inclucing 95% of CTX-M-3, 2% of CTX-M-15, and one probable mutant on sequence.

並列關鍵字

ESBL ； CTX-M ； antibiotic ； cephalosporins ； RCW

參考文獻

Abdel-Hady, H., Hawas, S., El-Daker, M., and El-Kady, R. (2008). Extended-spectrum beta-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit. J Perinatol 28, 685-690.

Apisarnthanarak, A., Kiratisin, P., Saifon, P., Kitphati, R., Dejsirilert, S., and Mundy, L. M. (2007). Clinical and molecular epidemiology of community-onset, extended-spectrum beta-lactamase-producing Escherichia coli infections in Thailand: a case-case-control study. Am J Infect Control 35, 606-612.

Arpin, C., Dubois, V., Coulange, L., Andre, C., Fischer, I., Noury, P., Grobost, F., Brochet, J. P., Jullin, J., Dutilh, B., Larribet, G., Lagrange, I., and Quentin, C. (2003). Extended-spectrum beta-lactamase-producing Enterobacteriaceae in community and private health care centers. Antimicrob Agents Chemother 47, 3506-3514.

Behar, P. R., Teixeira, P. J., Fachel, J. M., and Kalil, A. C. (2008). The effect of control group selection in the analysis of risk factors for extended spectrum beta-lactamase-producing Klebsiella pneumoniae infections. A prospective controlled study. J Hosp Infect 68, 123-129.

Bell, J. M., Turnidge, J. D., Gales, A. C., Pfaller, M. A., and Jones, R. N. (2002). Prevalence of extended spectrum beta-lactamase (ESBL)-producing clinical isolates in the Asia-Pacific region and South Africa: regional results from SENTRY Antimicrobial Surveillance Program (1998-99). Diagn Microbiol Infect Dis 42, 193-198.