從1920年代末Alexander Fleming發現青黴素（penicillin）開始，抗生素徹底改變了醫學領域，隨後開始20多年抗生素的發展，但在1990年開始出現從未發生過的感染症，抗生素的開發卻跟不上感染症的變化，後線的碳青黴烯類（carbapenem）也產生抗藥性，稱為碳青黴烯類抗藥性腸桿菌（carbapenem-resistant Enterobacteriaceae, CRE）。部分菌株可藉由基因表現產生碳青黴烯酶（carbapenemase）分解carbapenem，稱為產碳青黴烯酶腸內菌（carbapenemase-producing Enterobacteriaceae, CPE）。其中最常見且研究較多的抗藥性基因為blaKPC（Klebsiella pneumoniae carbapenemase, KPC）及blaNDM-1（New Delhi metallo-β-lactamase 1, NDM-1），帶著抗藥性基因的菌株逐漸增加，導致治療更加困難。
CRE感染的死亡率可高達五成，更令人擔憂的是腸桿菌科菌株之間可以藉由質體或是線毛互相傳遞KPC及NDM這類抗藥基因，使得CRE的存在問題更顯嚴重。乳酸桿菌（Lactobacillus spp.）能產生乳酸及醋酸等有機酸、過氧化氫、抗菌胜肽等物質，進而抑制腸道內病原菌的生長，減少細菌感染發生。
而根據實驗室先前的研究證實在體外實驗中乳酸桿菌以產生乳酸及醋酸等有機酸降低酸鹼值為主要的抑菌機轉。在本研究中我們將測試不同的益生元（prebiotics）對乳酸桿菌產酸抑菌能力的影響。結果顯示，不同的益生元對不同株乳酸桿菌產酸能力都不同。後續將進行體外抑菌能力的試驗，以篩選出抑菌能力效果較佳的乳酸桿菌及搭配的益生元，以利後續經由進入動物活體實驗研究益生元協同乳酸桿菌對腸道內KPC菌株抑制的效果。

Since the discovery of penicillin by Alexander Fleming in the late 1920s, antibiotics have completely changed the field of medicine. However, antibiotic resistance among bacteria always rapidly develop after the development of novel antibiotic. There is no exception for carbapenem – a broad-spectrum antibiotic, which is commonly used in severe infectious disease. Among carbapenem-resistant Enterobacteriaceae (CRE), some strains which can produce carbapenemase are known as carbapenemase-producing Enterobacteriaceae (CPE). blaKPC (Klebsiella pneumoniae carbapenemase, KPC) and blaNDM-1 (New Delhi metallo-β-lactamase 1, NDM-1) are the most common carbapenem-related antibiotic resistant mechanism and their increases make treatment more complicated than before. The mortality rate of CRE infection can be as high as 50%. What is more worrying is that the Enterobacteriaceae strains can transfer drug resistance genes such as KPC and NDM to each other through plasmids or sex pili.
Lactobacillus spp. can produce organic acids such as lactic acid and acetic acid, hydrogen peroxide, antibacterial peptides and other substances, thereby it can help inhibit the growth of intestinal pathogenic bacteria and reduce the development of bacterial infections.
According to previous in vitro research, it has been confirmed that Lactobacillus produces organic acids such as lactic acid and acetic acid to reduce the pH value, which is the main anti-bacterial mechanism. In this study, we will test the effect of different probiotics on the acid production and bacteriostatic ability of Lactobacillus. Initially, this study determined that different probiotics have different acid production capacities for different strains of Lactobacillus. The antibacterial ability test was to detect the Lactobacillus with best antibacterial ability and prebiotics, so as to facilitate the subsequent study about the inhibitory effect of probiotics and Lactobacillus on KPC strains in the intestine through animal experiments.

中文摘要 I
Abstract III
謝 誌 Ⅴ
目 錄 VII
附表目錄 X
附圖目錄 XI
表 目 錄 XII
圖 目 錄 XIII
縮寫對照表 XIV
第一章 緒論 1
第一節 前言 1
第二節 文獻回顧 3
一、 腸桿菌科（Enterobacteriaceae） 3
二、 抗生素抗藥性（Antibiotics resistance） 5
三、 碳青黴烯類抗藥性腸桿菌（Carbapenem-resistant Enterobacteriaceae, CRE） 7
四、 產碳青黴烯酶腸內菌（Carbapenemase-producing Enterobacteriaceae, CPE） 9
五、 台灣盛行狀況 12
六、 益生菌（Probiotic） 13
七、 益生元（Prebiotic） 14
八、 合生元（Synbiotic） 23
九、 乳酸桿菌（Lactobacillus） 25
第二章 材料與方法 37
第一節 實驗材料及儀器 37
一、 實驗使用之菌株 37
二、 培養基 37
三、 實驗使用之藥品 39
四、 實驗儀器 39
第二節 實驗假說與設計 41
第三節 實驗方法 47
一、 菌株培養 47
二、 體外抑菌實驗 47
第三章 結果與討論 52
第一節 微量肉湯稀釋法（Broth microdilution assay）-乳酸桿菌 52
第二節 益生元-乳酸桿菌產酸能力與生長狀況（Growth test） 53
第三節 微量肉湯稀釋法（Broth microdilution assay）-益生元-乳酸桿菌 54
第四節 時間殺菌曲線試驗（Time killing test） 55
第五章 結論 60
參考文獻 62

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