- 學位論文
台灣南部抗藥性大腸桿菌之流行病學研究與兒童糞便帶原之盛行率及其危險因子
Drug-Resistant Escherichia coli in Southern Taiwan: Epidemiology, Prevalence and Intrafamiliar Risk Factors for Children Fecal Carriage
摘要
背景：抗藥性大腸桿菌（Escherichia coli, E. coli）的流行迅速增加是一個全球關注的問題。本研究旨在探討兒童糞便中帶原有抗藥性大腸桿菌和腸外致病性大腸桿菌（extraintestinal pathogenic E. coli, ExPEC）之盛行率和其危險因子。 方法：本研究共有 179 名兒童參加。收集了 超廣譜乙內酰胺酶（extended-spectrum β-lactamase, ESBL）產生和抗生素藥物敏感性的數據，檢測超廣譜乙內酰胺酶，並進一步使用聚合酶鍊式反應測定抗菌藥物敏感性測試、超廣譜乙內酰胺酶分型、序列分型和腸外致病性大腸桿菌。此外，我們並且記錄問卷，於問卷中個案的生活環境、飲食、用水習慣、用藥等等資料，與糞便中的抗藥性大腸桿菌的帶原，進行風險因子分析。 結果：在這些大腸桿菌菌株中，多重抗藥性的菌株占了44.1%，20.7% 產生超廣譜乙內酰胺酶，50.3% 為腸外致病性大腸桿菌，另有3.3% 對colistin 有抗藥性（plamid mediated colistin resistance-1, mcr-1陽性）。比較兒童糞便中的大腸桿菌是否產生超廣譜乙內酰胺酶大腸桿菌，發現糞便中攜帶超廣譜乙內酰胺酶大腸桿菌的兒童平均年齡明顯比攜帶非超廣譜乙內酰胺酶菌株的兒童年輕。一些人為因素，包括飲用水處理、豬肉攝入量、寵物的飼養和家庭密度，可能與產生超廣譜乙內酰胺酶的大腸桿菌、序列類型131型大腸桿菌或腸外致病性大腸桿菌的腸道帶原有關。 對有寵物的參與者而言，若是居住在人口相對較多的房屋者，可能會比居住在較不擁擠的房屋中的家庭者，會有著超廣譜乙內酰胺酶大腸桿菌、ST131型大腸桿菌或腸外致病性大腸桿菌的腸道帶原較高的風險。 結論：兒童腸道帶原超廣譜乙內酰胺酶大腸桿菌的比例很高。除了對人和牲畜的抗生素控制外，改變飲用水、食物、寵物、家庭密度和社會經濟地位等因素的改善，可能可以減少抗藥性的大腸桿菌和腸外致病性大腸桿菌的腸道帶原的風險，並為減輕社會醫療負擔提供一個潛在契機。
並列摘要
Background: The rapidly increasing prevalence of antimicrobial-resistant Escherichia coli (E. coli) is a global concern. This study determined the prevalence of and risk factors for the fecal carriage of drug-resistant E. coli and extraintestinal pathogenic E. coli (ExPEC) among children. Materials and methods: A total of 179 children participated between April 2016 and March 2019. Data on extended-spectrum β-lactamase (ESBL) production and antimicrobial susceptibility were gathered, and ESBLs were further detected. Antimicrobial susceptibility testing, enzyme typing for ESBL, sequence typing, and ExPEC were determined using polymerase chain reactions. Questionnaires were recorded for risk factor analysis. Results: Among these instances of E. coli, 44.1% were multi-drug resistant, 20.7% produced ESBL, 3.3% were mobilized colistin resistance-1 (mcr-1), and 50.3% were ExPEC. Children carrying ESBL-producing E. coli were younger than those carrying non-ESBL strains. Several anthropogenic factors, including drinking water process, pork consumption, pets and household density are associated with ESBL-producing E. coli, ST131 E. coli, or ExPEC fecal carriage. Compared with families who live in less crowded houses, participants with pets might have higher risks of ESBL-producing E. coli, ST131 E. coli, and ExPEC fecal carriage than those living in houses accommodating relatively more people. Conclusions: Children accounted for a large proportion of instances of feces carrying ESBL bacteria. In addition to antimicrobial control for people and livestocks, avenues of exposure, such as drinking water, food, pets, household density, and socioeconomic deprivation are modifiable in principle and may present potentially novel opportunities to reduce the burden of nonsusceptible E. coli and ExPEC.
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