對Oxacillin有抗藥性的金黃色葡萄球菌所引起之耳鼻喉頭頸部感染

背景：根據統計Oxacillin Resistant Staphylococcus Aureus （ORSA）感染在耳鼻喉頭頸部有日漸增加的趨勢。本研究針對細菌培養結果為ORSA的病患，分析其細菌之抗藥性、病患之臨床表現及治療預後是否與具致病危險因子有關。希望能了解細菌產生抗藥性的特性，並合理有效地使用抗生素以達到最好的預後。方法：本研究採回溯性方式，從2003年06月至2009年07月，收集診斷為耳鼻喉頭頸部感染，採集膿性分泌物檢體細菌培養結果為ORSA的病患。我們詳細記錄病患是否有感染住院病史、是否曾經接受感染部位手術、細菌培養前是否接受抗生素的治療以及是否有其他之重大疾病（如：頭頸部癌症接受放射治療）並定義上述為危險因子。依有無上述危險因子將病患分為二組，一組具危險因子組（Risk factors group, RFG）；另一組為不具危險因子組（No risk factors group, NRFG）。以Chi-Square Tests分析兩組病患的臨床症狀、抗藥性的表現、復發率、治療過程和多菌性感染狀況的差異性。結果：6年來，共收集60名，男性34名，女性26名，其中30名屬於RFG，另外30名屬於NRFG。兩組病人之年齡、性別、疾病發作時間及抗生素治療時間，在統計學上皆無顯著差異。NRFG與RFG治療後復發比率分別16.7％與53.3％，在統計學上有顯著相關（p＝.003）。Trimethoprim-sulfamethoxazole（TMP-SMX）於兩組的抗藥性雖不具有顯著差異（p＝.245），但對於RFG有較高抗藥性的趨勢；RFG對於gentamycin有較高的抗藥性，在統計學上有顯著的差異（p＝.049）。兩組對於erythromycin與clindamycin都約有8到9成極高的抗藥性，雖然在統計學上兩組間是沒有顯著的差異；兩組對teicoplanin、vancomycin和fucidic acid的敏感性為100％或極接近100％。結論：我們統計發現兩組菌株對許多抗生素已具抗藥性，特別是gentamycin在具危險因子組病患上有顯著較高的抗藥性。對於TMP-SMX，在具危險因子的病患有較多抗藥性的傾向，於臨床上需小心使用及追蹤。具危險因子的病患有較高的復發率，在統計學上是有顯著的意義。

關鍵字

具抗藥性的金黃色葡萄球菌；抗藥性；頭頸部感染

並列摘要

BACKGROUND: Infections affecting the ear, nose, throat, head and neck due to oxacillin resistant Staphylococcus aureus (ORSA) have been increasing recently. This study explores the correlations between pathogenesis associated high risk factors and antimicrobial resistance, symptoms, and treatment prognosis among ORSA patients using bacterial culture. The results identify the antimicrobial resistance characteristics of the S. aureus and thus will help with planning the effective use of antibiotics in the future in order to obtain a better patient prognosis.METHODS: From June, 2003 to July, 2009, 60 patients, consisting of 34 males and 26 females, were retrospectively diagnosed as having an ORSA infection. The patients were divided into a risk factor group (RFG) and a no risk factor group (NRFG). The risk factors were a history as an infected and hospitalized patient, having had an operation, having undergone antibiotic treatment(s) before bacterial culture, and having undergone any other significant disease treatment affecting the patient, including radiation treatment for head and neck cancer. The patient's clinical symptoms, the antimicrobial resistance profile of the bacteria, the recurrence rate of the infection, the course of treatment and the polymicrobial infection rate were compared between these two groups using χ^2 tests.RESULTS: There were no statistically significant differences in age, sex, morbidity timing, and duration of antibiotic treatment between the two groups. The results showed that the recurrence rates for the RFG and NRFG groups were 53.3% and 16.7%, respectively, and that the difference was statistically significant (p=0.003). Although there was no significant difference (p=0.245) between the two groups with respect to TMP-SMX resistance, a trend towards bacterial such resistance was present in the RFG group. In addition, the number of gentamycin resistant bacteria isolated from the RFG groups was significantly higher than that from the NRFG group (p=0.049). Overall, 80% to 90% of the isolated bacteria were resistant to erythromycin and clindamycin in both groups. However, there was almost 100% bacterial sensitivity to teicoplanin, vancomycin and fucidic acid in both groups. Overall, there were no significant difference in bacterial resistance to erythromycin, clindamycin, teicoplanin, vancomycin and fucidic acid between the two groups..CONCLUSIONS: CONCLUSIONS: Various types of antimicrobial resistance were found to be present in the bacteria isolated from the two ORSA groups. Specifically, there was a statistically significant higher frequency of resistance to gentamycin among the bacteria isolated from the risk factor group. In addition, there was also a trend towards a higher frequency of TMP-SMX resistance among bacteria from the risk factors group.

並列關鍵字

oxacillin resistant Staphylococcus aureus ； antibiotic resistant ； head and neck infection

國際替代計量

對Oxacillin有抗藥性的金黃色葡萄球菌所引起之耳鼻喉頭頸部感染

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