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頁籤選單縮合
題 名 | 困難梭狀芽孢桿菌國內外現況分析=Epidemiological Survey of the Multiple Antibiotic Resistant Human Pathogen Clostridium difficile |
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作 者 | 洪羽屏; 蘇資茜; 黃一修; 林建州; 吳和生; | 書刊名 | 疫情報導 |
卷 期 | 31:4 2015.02.24[民104.02.24] |
頁 次 | 頁86-93 |
分類號 | 415.27 |
關鍵詞 | 困難梭狀芽孢桿菌; 困難梭狀芽孢桿菌感染症; 正常菌叢; 定殖抗性; 分子型別調查; |
語 文 | 中文(Chinese) |
中文摘要 | 困難梭狀芽孢桿菌 (Clostridium difficile) 是一種革蘭氏陽性、會產生內孢子的人類致病菌,通常與抗生素所造成的腹瀉相關。困難梭狀芽孢桿菌感染症 (CDI) 的症狀包括腹瀉 (diarrhea)、偽膜性腸炎 (pseudomembranous colitis) 和巨結腸症 (megacolon) 等,通常是服用廣效性抗生素(broad-spectrum anti-microbial agent)而破壞了正常菌叢 (indigenous microbiota) 所提供的定殖抗性 (colonization resistance) 所導致。造成CDI相關症狀的主因為TcdA和TcdB兩種毒素,目前CDI的治療,先建議停止目前使用的抗生素,再依照其疾病嚴重程度使用甲嘧唑乙醇 (metronidazole) 及萬古黴素 (vancomycin)。新型抗生素fidaxomicin可針對再復發之CDI做更有效的治療。在預防方面,目前尚無有效的疫苗可供預防,而以不活化TcdA和TcdB為基礎的疫苗正在研究中。北美與許多歐洲國家,高致病性菌株的出現以及高致死率,是導致CDI愈來愈嚴重的主因,在亞洲國家的發生率也逐漸攀升。臺灣的一份研究報告指出,2003-2007年間,65歲以上的病人CDI感染個案增加了5-6倍,所以感控人員應注意CDI案例的增加趨勢,必要時需進行分子型別調查 (molecular typing)。由於C. difficile的擴散及傳播快速,增加區域性的監測有其必要性。 |
英文摘要 | Clostridium difficile is an endospore-forming, Gram-positive human pathogen and is the leading cause of antibiotic-associated diarrhea. Ingestion of broad-spectrum anti-microbial agents are often the trigger for C. difficile infections (CDI) which result in a wide range of symptoms ranging from diarrhea, pseudomembranous colitis to the lethal toxic megacolon. A major cause of CDI is the disruption of indigenous microbiota by the anti-microbial agents and the presence of C. difficile in the gut mucosa which leads to colonization resistance. The two major virulence factors of C. difficile are the TcdA and TcdB toxins. The current treatment of CDI first calls for the cessation of broad-spectrum antibiotics, followed by the administration of metronidazole and/or vancomycin depending on disease severity. Currently, C. difficile vaccines based on toxoid preparations are under clinical trial but have not been approved to be used for the general public. The emergence of hyper-virulent C. difficile strains have contributed to increasing mortality in North America and many other European nations. The incidence in Asian countries is gradually rising as well. Between 2003 and 2007, the number of confirmed CDI patients among the 65 years or older group has increased by 5 to 6 fold. It is pertinent for infection control personnel in hospitals to raise awareness for CDI cases here in Taiwan, and to perform molecular typing when necessary. Since C. difficile is known to spread rapidly, increase geographical monitoring of CDIs is also recommended. |
本系統中英文摘要資訊取自各篇刊載內容。