臺灣博碩士論文加值系統

本院所分離之所有鮑氏不動桿菌對carbapenem的抗藥性從2005年之2.6%上升到2006年的29.6%。引起院內感染事件的鮑氏不動桿菌對carbapenem的抗藥性也從2006年的36%上升到2007年的58%。從2007年01月到09月，收集全院對carbapenem有抗藥性之鮑氏不動桿菌不重複菌株共175株。這175株細菌檢體來源的6成來自加護病房病人的呼吸道檢體，而且這175株細菌對其它常規檢驗之抗生素也多呈抗藥性，包括ampicillin/sulbactam。隨機選取175株抗imipenem鮑氏不動桿菌中的28株進行後續研究，這28株中有27株為本院院內感染菌株。我們使用自動化微生物分析儀(Phoenix)進行最低抑菌濃度(MIC)之測試，結果顯示除colistin有100%感受性(MIC範圍 0.5-1 ?慊/ml)，其餘藥物之抗藥性皆超過90%。使用等電點聚焦法及聚合酶鏈鎖反應法鑑別引起carbapenem抗藥性的乙內醯胺酶，之後依據DNA序列進一步確認乙內醯胺酶種類，發現所有28隻對carbapenem有抗藥性之鮑氏不動桿菌都具有blaOXA-66(100%)，26隻菌株具有blaOXA-23（92.9%）。ISAba1分別在25株具有blaOXA-23及28株具有blaOXA-66基因的上游被發現。另外取8株對imipenem具感受性之鮑氏不動桿菌，發現各有6隻菌株具有blaOXA-23或blaOXA-66，在這些對imipenem具感受性之鮑氏不動桿菌中，只有一株細菌blaOXA-23前有ISAba1存在，有五株細菌blaOXA-66前有ISAba1存在，blaOXA-23上游ISAba1存在情形在對imipenem具感受性及不具感受性兩者之間有明顯差異。我們將28株對imipenem不具感受性之鮑氏不動桿菌菌株使用脈衝式膠體電泳法進行基因分型，總共有16個基因分型。依據Bionumeric 軟體的分析結果，可將這些菌株分成4個群集。其中cluster A有14株（50%），cluster C有8株 (28.6%)。我們的研究結果顯示具有carbapenem抗藥性的鮑氏不動桿菌正在本院增加中，這些鮑氏不動桿菌多同時能產生OXA-23及OXA-66，而且blaOXA-23前有也都有ISAba1存在。在本院流行對imipenem具抗藥性之鮑氏不動桿菌主要是cluster A及cluster C兩個流行菌株所組成。

The number of carbapenem-resistant Acinetobacter baumannii isolates significantly increased in our hospital from 2002 to 2006. Twenty-eight clinical isolates of carbapenem-resistant A. baumannii were collected between January and September 2007. Isoelectric focusing and polymerase chain reaction (PCR) experiments were used for preliminary identification of the carbapenem-resistant beta-lactamases. They were further identified by DNA sequencing. All of the isolates harbored blaOXA-66(100%) and twenty-six (92.9%) of the isolates were found to produce blaOXA-23. ISAba1 in upstream of blaOXA23 and blaOXA-66 were detected in 25 isolates and 28 isolates respectively. Typing of strains was performed using pulsed-field gel electrophoresis (PFGE), and 16 different genotypes were identified. Four clusters were identified and designated A, B, C and D according to the published interpretation criteria. Forteen isolates belonged to cluster A, and eight isolates belonged to cluster C. Our results indicate that the increase in the number of carbapenem-resistant beta-lactamase-producing A. baumannii isolates in our hospital is due mainly to the dissemination of a cluster A epidemiologic strain with OXA-23 beta-lactamase.

目錄
英文摘要 I
中文摘要 II
致謝 IV
目錄 V
表目錄 VIII
圖目錄 X
第一章 前言 1
第1節 研究背景 1
1.1鮑氏不動桿菌簡介 1
1.2抗生素之簡介 2
1.3乙內醯胺類(??-lactam)抗生素 5
1.4細菌抗藥性機制 6
1.5乙內醯胺酶的介紹 9
1.6Oxacillinase簡介 12
第二節 研究目的 13
第二章 材料方法 14
第1節研究材料 14
第2節研究設計 15
1.菌株來源 15
2.抗生素敏感性試驗 15
3.乙內醯胺酶等電點聚焦分析 20
4.DNA分析 24
5.聚合酶鏈鎖反應 28
6.定序與序列比對 29
7.脈衝式膠體電泳 30
第三章 研究結果 34
第1節鮑氏不動桿菌抗藥性的持續上升 36
第2節多重抗藥性之鮑氏不動桿菌 37
第3節具有OXA-23及OXA-66之鮑氏不動桿菌 38
第4節ISAba1存在鮑氏不動桿菌blaOXA-23及blaOXA-66上游 38
第5節兩個主要鮑氏不動桿菌流行菌株 38
第四章 討論 40
第1節持續上升之抗藥性 40
第2節多重抗藥性鮑氏不動桿菌 41
第3節具有OXA-23及OXA-66之鮑氏不動桿菌 43
第4節同時存在OXA-23及OXA-66乙內醯胺酶 44
第5節ISAba1存在鮑氏不動桿菌blaOXA-23及blaOXA-66上游 45
第6節兩個主要的流行菌株 48
第7節研究限制 48
第五章 結論與建議 51
第一節 結論 51
第二節 建議 53
參考文獻 54
圖 58
表 60
附錄 73

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