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研究生:呂春美
研究生(外文):Chun-Mei Lu
論文名稱:醫院作業環境與飲食習慣對胃腸道大腸桿菌抗藥性程度之影響
論文名稱(外文):The Effects of Working Environments and Dietary Habits on the Incidence of Antibiotic-resistant Escherichia coli Isolated from Human Feces
指導教授:洪慶宜洪慶宜引用關係
指導教授(外文):Ching-Yi Horng
學位類別:碩士
校院名稱:長榮大學
系所名稱:職業安全與衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
語文別:中文
論文頁數:66
中文關鍵詞:醫院作業環境飲食習慣大腸桿菌抗藥性
外文關鍵詞:HospitalWorking EnvironmentDietary HabitAntibiotic-resistantEscherichia coli
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本研究在探討醫院作業環境、不同葷素的飲食習慣,是否對人體胃腸道中的Escherichia coli (E. coli) 抗藥性造成影響,選擇Penicillins、Aminoglycosides、第一、二、三代Cephalosporins、Quinolones、Tetracyclines、Phenicols、Sulfonamides、Carbapenems等不同類的抗生素做為研究並進行其抗藥性程度分析。在「醫院環境及醫療人員胃腸道之大腸桿菌抗藥性調查」研究,目的在瞭解醫院環境所存在的E. coli 是否具抗藥性及可能對醫療人員胃腸道E. coli 抗藥性的影響,選定內科加護病房(Medical Intensive Care Unit, MICU)為研究環境。分別各採集環境(31株)及醫療人員E. coli (41株)並對照病人臨床檢體分離E. coli (38株)進行各組間之抗藥性統計分析,結果發現:(1)從醫療人員分離E. coli 的抗藥性程度明顯低於環境採檢、臨床檢體 (P<0.05)。(2)環境分離E. coli 的抗藥性程度明顯高於醫療人員、臨床檢體(P<0.05)。(3)MICU醫療人員(29株)及非MICU醫療人員(11株)分別所分離的E. coli 抗藥性程度大多呈現沒有顯著差異(P >0.05)。初探顯示醫院環境應該不會影響醫療人員胃腸道E. coli的抗藥性程度;但在一般認為乾淨的區域卻可發現抗藥性E. coli,此結果應該被重視,結果顯示注意環境清潔的範圍必須概括加護病房的每個區域。
「不同飲食習慣對人體胃腸道E. coli之抗藥程度影響」研究,目的在探討人類可能經由不同的攝食途徑,造成抗藥性微生物進入體內,依照葷食、素食兩組的糞便收集,分別各採集有葷食(72株)、素食(37株)共109株E. coli 進行抗藥性程度統計分析。結果發現兩組對大多的抗生素的抗藥性並無顯著差異,僅對Gentamicin呈現顯著不同(P<0.05)。對於環境與食物可能感染抗藥性E. coli 的來源,造成人體胃腸道E. coli抗藥性程度的影響因素,建議未來進一步找出根本原因,做為未來在醫政、藥政、食品衛生管理對抗生素之相關管制措施之參考依據。
Antibiotic-resistant bacteria can exist in hospital environments and the meat contents. The antibiotic resistance can also be transmitted among bacteria. The study is to explore to what extent hospital environments and dietary habits have effects on antibiotic-resistant Escherichia coli (E. coli) in gastrointestinal tract of humans. Antibiotics of Penicillins, Aminoglycosides, the first-, second- and third-generation Cephalosporins, Quinolones, Tetracyclines, Phenicols, Sulfonamides, and Carbapenems were used as the test antibiotics to proceed with the analysis of antibiotic-resistant degree.
In chapter “Survey of Antibiotic-resistant E. coli in hospital environments and the gastrointestinal tract of healthcare workers“, the study is to explore whether E. coli existing in hospital environments was antibiotic-resistant, and to what extent E. coli may have an effect on the antibiotic-resistant E. coli in gastrointestinal tract of healthcare workers. We chose medical intensive care unit (MICU) as our research location. 31 samples from hospital environments, 41 samples from healthcare workers and 38 samples from clinical patients were collected to isolate the antibiotic-resistant E. coli, and the data were analyzed by chi-square test. The results showed that the antibiotic-resistant E. coli isolated from healthcare workers had lower antibiotic resistance than those from hospital environments and clinical patients (p<0.05); the antibiotic-resistant E. coli isolated from hospital environments had higher antibiotic resistance than those from healthcare workers and clinical patients. Therefore, the study demonstrated that hospital environments have no effect on the antibiotic-resistant E. coli in the gastrointestinal tract of healthcare workers. However, we should pay much attention that the antibiotic-resistant E. coli was found in the areas we thought to be clean, so routine and complete cleaning of every area in MICU are very important.
In chapter “Effect of antibiotic-resistant E. coli existing in gastrointestinal tract of humans with different dietary habits“, the study is to explore that humans may acquire antibiotic-resistant bacteria through different dietary habits. We collected 72 samples from non-vegetarians and 37 samples from vegetarians to analyze the antibiotic resistance by chi-square test. The results were that both groups only had a significant difference on Gentamicin (p<0.05). In addition, both groups show no significant differences on other antibiotics.
In conclusion, the study evaluated the potential risk of humans exposing in environments full of bacteria, and the effect on antibiotic-resistant differences from occupational environments and dietary habits. Our results can be contributed as guidelines to deal with the related executive measures of antibiotics in the future.
誌 謝 I
中文摘要 III
目 錄 VII
表 目 錄 IX
第一章 緒 論 12
第二章 醫院環境及醫療人員胃腸道之大腸桿菌抗藥性調查 20
2.1 研究背景 20
2.2 研究目的 22
2.3 研究預期效益 22
2.4 材料與方法 23
2.4.1 背景描述 23
2.4.2 環境及醫療人員人體胃腸道大腸桿菌之採集 23
2.4.3 臨床最常分離大腸桿菌之檢體分佈分析 23
2.4.4 大腸桿菌鑑定方法 24
2.4.5 抗生素選用及瓊脂紙錠擴散實驗(Agar disc diffusion test) 25
2.4.6 統計分析 25
2.5 結 果 26
2.5.1 內科加護病房的環境區域採樣及大腸桿菌陽性培養率 26
2.5.2 全院及內科加護病房臨床檢體分離致病菌大腸桿菌的分佈 26
2.5.3 醫療人員之胃腸道大腸桿菌採樣結果及其抗藥性程度分析 26
2.5.4 比較內科加護病房環境、臨床檢體分離大腸桿菌的抗藥性程度 27
2.5.5 比較內科加護病房環境、醫療人員的胃腸道分離大腸桿菌的抗藥性程度 27
2.5.6 比較內科加護病房、非內科加護病房醫療人員的胃腸道分離大腸桿菌的抗藥性程度 27
2.5.7 比較內科加護病房臨床檢體、醫療人員的胃腸道分離大腸桿菌的抗藥性程度 27
2.6 討論 29
2.7 結論與建議 33
第三章 不同飲食習慣對人體胃腸道大腸桿菌之抗藥程度影響 42
3.1 序論 42
3.2 研究目的 44
3.3 預期效益 44
3.4 材料與方法 44
3.4.1 研究對象 44
3.4.2 糞便檢體之收集 44
3.4.3 大腸桿菌之培養 44
3.4.4 抗生素選用及瓊脂紙錠擴散實驗(Agar disc diffusion test) 45
3.4.5 統計分析 45
3.5 結 果 45
3.5.1 所有樣本族群基本資料 45
3.5.2 本次研究族群之胃腸道分離大腸桿菌的抗藥性程度分析 45
3.5.3 比較葷、素族群之胃腸道分離大腸桿菌的抗藥性程度 45
3.5.4 葷、素族群之胃腸道大腸桿菌多重抗藥性分佈 46
3.6 討論與建議 47
第四章 討論與結論 54
參考文獻 59
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1. 呂旭峰,鄒梅芬,蔡惠貞,張雅欣,吳嘉齡,薛樹清 (2002) "人畜共用抗生素-安巴素(avoparcin)造成的潛在性危機 " 院內感染控制雜誌, 12(1), 31-43.
2. 呂旭峰,鄒梅芬,蔡惠貞,張雅欣,吳嘉齡,薛樹清 (2002) "人畜共用抗生素-安巴素(avoparcin)造成的潛在性危機 " 院內感染控制雜誌, 12(1), 31-43.
3. 張上淳 (2003) "台灣近年來抗生素使用改善措施及其影響" 感染控制雜誌, 13(2), 33-42.
4. 張上淳 (2003) "台灣近年來抗生素使用改善措施及其影響" 感染控制雜誌, 13(2), 33-42.
5. 張上淳,陳美文,林美智,胡幼圃 (2003) "台灣人用抗生素與動物用抗生素使用量之調查研究" 感染控制雜誌, 13(6), 334-345.
6. 張上淳,陳美文,林美智,胡幼圃 (2003) "台灣人用抗生素與動物用抗生素使用量之調查研究" 感染控制雜誌, 13(6), 334-345.
7. 張上淳,陳宜君,賴美淑,張鴻仁 (2006). "台灣住院病人2000─2004年抗生素使用之情形 " 感染控制雜誌, 16(4), 205-218.
8. 張上淳,陳宜君,賴美淑,張鴻仁 (2006). "台灣住院病人2000─2004年抗生素使用之情形 " 感染控制雜誌, 16(4), 205-218.
9. 陳淑惠,趙玉玲,張玉雯 (2003) "南部某區域醫院院內感染調查分析 "感染控制雜誌, 13(6), 346-353.
10. 陳淑惠,趙玉玲,張玉雯 (2003) "南部某區域醫院院內感染調查分析 "感染控制雜誌, 13(6), 346-353.
11. 楊采菱 (2006) "台灣近年的細菌抗藥性演變" 科學月刊, 433, 44-52.
12. 楊采菱 (2006) "台灣近年的細菌抗藥性演變" 科學月刊, 433, 44-52.
13. 楊采菱,陳珮琛,蕭溢茹,王惠瑩,賴瑞芬 (2003) "大腸桿菌Escherichia coli對quinolones (quinolone及fluorouinolone)感受性降低及抗藥性之關聯" 感染控制雜誌, 13(6), 366-371.
14. 楊采菱,陳珮琛,蕭溢茹,王惠瑩,賴瑞芬 (2003) "大腸桿菌Escherichia coli對quinolones (quinolone及fluorouinolone)感受性降低及抗藥性之關聯" 感染控制雜誌, 13(6), 366-371.