台灣山地鄉居民桿菌性痢疾之危險因子及抗藥性之探討

The Study on Risk Factors and Drug Resistance of Shigellosis among Residents of Mountain Area in Taiwan

羅秀雲(Hsiu-Yun Lo)

指導教授 ： 薛玉梅教授

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(2001年)

摘要

摘要 本研究收集並分析台灣北部地區1991-2000年桿菌性痢疾個案之性別、年齡、季節、地區之分布情形及相關性，另選擇台灣地區桿菌性痢疾病例數較多之宜蘭縣大同、南澳鄉、花蓮縣卓溪、萬榮鄉、台東縣達仁、海端、蘭嶼鄉、桃園縣復興鄉、新竹縣尖石、五峰鄉、南投縣信義鄉等山地鄉地區，以問卷之方式，收集2000年9月至2001年4月桿菌性痢疾陽性個案及其接觸者之人口學特徵、環境衛生及個人衛生習慣等資料，以探討疾病與危險因子之相關性，此外也收集菌株做抗生素感受性試驗，以瞭解菌株抗藥性型態。研究結果顯示台灣北部地區1991-2000年桿菌性痢疾之流行，主要集中於秋、冬兩季；罹病之年齡層以學齡前及學齡兒童較多；感染之菌型主要以S.sonnei和S.flexneri常見。此外山地鄉和非山地鄉之個案，在罹病季節及菌屬方面有顯著之差異性，山地鄉個案以夏、秋兩季較多，主要菌屬為S.flexneri；非山地鄉以秋、冬兩季個案數較多，主要菌屬為S.sonnei；食物冰存與否、飯前是否洗手、家中垃圾清理頻率與疾病之發生有顯著相關。抗藥性之研究發現不同菌屬間抗藥性不盡相同。歷年來山地鄉桿菌性痢疾之發生率均高於非山地鄉，因此需探討疾病之發生與危險因子之相關性，以作為未來山地鄉桿菌性痢疾防治工作之參考；且研究發現桿菌性痢疾已對常用之抗生素產生抗藥性，因此需適當控制抗生素之使用及持續監測菌株之抗藥性，以作為未來用藥之參考。 關鍵字：桿菌性痢疾 抗藥性

關鍵字

桿菌性痢疾 ； 抗藥性

並列摘要

Abstract This study is to find the risk factors of shigella infection among the residents who lived in mountain areas and the drug resistant of the shigella isolates. Infected cases were collected and analyzed by distribution of sex, age, infectious seasons and resident areas, as well as the relationship between these risk factors and shigella infection. The study areas included Datong and Nanao villages of Ilan County, Zhuoxi and Wanrong villages of Hwalei County, Daren, Haiduan, Lanyu and Yanping villages of Taiton County, Fuxin village of Taoyuan County, Jianshi and Wufeng villages of Hsinzhu County and Xinyi village of Nantou County. The demographic characteristics, environment sanitation and health habits of the shigellosis cases and non-shigellosis of controls were collected by constructed questionnaire from August 2000 to May 2001. In addiction, the drug resistance of shigella isolates from cases were examed, by the disc diffusion examined. It was shown that majority of cases occurred in autumn and winter and they are preschool children and elementary students on northen Taiwan in 1991-2000. In mountain area cases infected by Shigella flexneri mainly occurred in summer and autumn. Non-mountain area, the cases who infected by Shigella sonnei occurred in autumn and winter. Whether or not foods were frozen, hands washing before eating or after toilet, the frequency of cleaning the trash in house were related with shigella infection. The different species of shigella had different drug resistance. Because the incidence of shigella in mountain areas were higher than non-mountain areas within last few years, it was important to elucidate the risk factors of the shigella infection in order to prevent the disease. Antibiotics were extensively abused, therefore we have to control and monitor the use of antibiotics in the future.

並列關鍵字

Shigella ； drug resistance

參考文獻

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