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題名 | 北臺灣一家醫學中心Klebsiella Pneumoniae菌株中具有ESBL的盛行率=The Prevalence of Extended-Spectrum β-Lactamase-Producing Klebsiella Pneumoniae in a Teaching Hospital in Northern Taiwan |
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作者姓名(中文) | 鐘佩雯; 黃玉成; 郭安靜; | 書刊名 | 院內感染控制雜誌 |
卷期 | 10:1 2000.02[民89.02] |
頁次 | 頁21-27 |
分類號 | 419.38 |
關鍵詞 | 抗生素; 抗藥性細菌; 微生素; 院內感染; K. pneumoniae; ESBL; Extended-spectrum β-lactamase; |
語文 | 中文(Chinese) |
中文摘要 | 在過去20年中,因微生物對抗生素感受素不斷的改變,讓我們警覺到抗藥性問題的增加及其重要性。自從大量使用廣效性頭芽孢子類抗生素(broad-spectrum cephalosporin)之後,能產生extended-spectrum β-lactamase(ESBL),即有抗藥性之腸道細菌越來越多,其中以以Klebsiella pneumoniae最常見。因此我們希望能偵測本院的K. pneumoniae菌株產生ESBL的情況,及其在院內的盛行率。在1999年5月21日999年6月17日之間,我們共收集了215株K. pneumoniae,分別來自血液、尿液、痰液、中央靜脈導管及其他來自病人的檢體所做的培養。抗生素敏感性試驗所採用的藥片試劑包括ceftriaxone(CRO,30μg),ceftazidime(CAZ,30μg),aztreonam(ATM,30μg)及amoxicillin-clavulanate(AMC,30μg-15μg)。ESBL的偵測採用double-disk test及three-dimensional test兩種方法,均是利用上述藥片來做測試。以double-disk test之結果發現,呈陽性反應者共有30株。Three-dimensional test之結果發現,呈陽性反應者共有22株。在所使用的三種抗生素中,又以CRO之偵測效果最好。無論是用double disk test或three-dimensional test,在215株K. pneumoniae中,均可偵測出30株能產生ESBL之K. pneumoniae,因此在本院可能產生ESBL之K. pneumoniae的盛行率是14%。推測院內ESBL盛行率並不低,應進一步偵測血液培養中能產生ESBL之K. pneumoniae的比率,期有助於選用適當的抗生素,不但能增加治療效果,也減少醫療資源的浪費。 |
英文摘要 | After the widespread use of the broad-spectrum cephalosporins, strains of Klebsiella pneumoniae resistant to these antimicrobial agents began to appear. K. pneumoniae has been prominent among the gram-negative bacilli causing nosocomial infections and an important source of transferable antibiotic resistance. We are concerned about the prevalence of extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae in our hospital and thus conducted this study. Totally 215 strains of K. pneumoniae isolated from various sites of patients in our hospital between 21 May and 17 June 1999 were included in this study. A double-disk synergy test and a three-dimen-sional test (both were performed with ceftriaxone, ceftazidime and aztreonam) were used to detect ESBL-producting K. pneumoniae. By the double-disk test, positive results were detected in 30 of the 215 strains. By the three-dimensional test, positive results were found in only 22 strains. Ceftriaxone is the best indicator among the three antibiotics screened in both methods. Positive results were found in 30 of the 215 strains tested by either double disk test or three-dimen-sional test, and the possible prevalence of ESBL-producting K.pneumoniae was estimated as 14% (30/215) in our hospital. The results showed that 14% of all K. pneumoniae isolates in our hospital are likely to produce ESBL although the DNA sequence has not yet been analyzed in this study. This suggests that treatment failure is likely to occur if a third generation cephalosporin was used to treat these organisms although the exact incidence of bacteremia caused by ESBL-producing K. pneumoniae is yet to be confirmed in our hospital. We conclude that the double-disk test is a more sensitive screening test for ESBL-producing strains in our hospital, but the use of a combination of both methods makes it easier for the investigator to interpret test results. This also help to prevent the infected patients to have dire consequences due to the delay in detection of th ESBL-productng pathogens. |
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