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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 方啟泰(Chi-Tai Fang) | |
dc.contributor.author | Chia-Wei Chang | en |
dc.contributor.author | 張嘉瑋 | zh_TW |
dc.date.accessioned | 2021-06-17T00:53:15Z | - |
dc.date.available | 2016-10-15 | |
dc.date.copyright | 2012-03-02 | |
dc.date.issued | 2011 | |
dc.date.submitted | 2011-10-19 | |
dc.identifier.citation | Barnaud, G., Arlet, G., et al. (1998). 'Salmonella enteritidis: AmpC plasmid-mediated inducible beta-lactamase (DHA-1) with an ampR gene from Morganella morganii.' Antimicrob Agents Chemother 42(9): 2352-2358.
Bou, G., Oliver, A., et al. (2000). 'OXA-24, a novel class D beta-lactamase with carbapenemase activity in an Acinetobacter baumannii clinical strain.' Antimicrob Agents Chemother 44(6): 1556-1561. Bradford, P. A. (2001). 'Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat.' Clin Microbiol Rev 14(4): 933-951, table of contents. Bradford, P. A., Bratu, S., et al. (2004). 'Emergence of carbapenem-resistant Klebsiella species possessing the class A carbapenem-hydrolyzing KPC-2 and inhibitor-resistant TEM-30 beta-lactamases in New York City.' Clin Infect Dis 39(1): 55-60. Bratu, S., Landman, D., et al. (2005). 'Detection of KPC carbapenem-hydrolyzing enzymes in Enterobacter spp. from Brooklyn, New York.' Antimicrob Agents Chemother 49(2): 776-778. Bratu, S., Landman, D., et al. (2005). 'Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: a new threat to our antibiotic armamentarium.' Arch Intern Med 165(12): 1430-1435. Cai, J. C., Zhou, H. W., et al. (2008). 'Emergence of Serratia marcescens, Klebsiella pneumoniae, and Escherichia coli Isolates possessing the plasmid-mediated carbapenem-hydrolyzing beta-lactamase KPC-2 in intensive care units of a Chinese hospital.' Antimicrob Agents Chemother 52(6): 2014-2018. Cao, V. T., Arlet, G., et al. (2000). 'Emergence of imipenem resistance in Klebsiella pneumoniae owing to combination of plasmid-mediated CMY-4 and permeability alteration.' J Antimicrob Chemother 46(6): 895-900. Chen, Y., Zhou, Z., et al. (2011). 'Emergence of NDM-1-producing Acinetobacter baumannii in China.' Journal of Antimicrobial Chemotherapy 66(6): 1255-1259. Chia, J. H., Su, L. H., et al. (2010). 'Development of high-level carbapenem resistance in Klebsiella pneumoniae among patients with prolonged hospitalization and carbapenem exposure.' Microb Drug Resist 16(4): 317-325. Chiang, T., Mariano, N., et al. (2007). 'Identification of carbapenem-resistant klebsiella pneumoniae harboring KPC enzymes in New Jersey.' Microb Drug Resist 13(4): 235-239. Chihara, S., Okuzumi, K., et al. (2011). 'First Case of New Delhi Metallo-β-Lactamase 1–Producing Escherichia coli Infection in Japan.' Clinical Infectious Diseases 52(1): 153-154. Clinical and Laboratory Standards Institute (2009). Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically : approved standard, Wayne, Pa. Clinical and Laboratory Standards Institute (2009). Performance standards for antimicrobial susceptibility testing : nineteenth informational supplement Wayne, Pa.: M100-S119. Clinical and Laboratory Standards Institute (2011). Performance Standards for Antimicrobial Susceptibility Testing; Twenty First Informational Supplement, Wayne, Pa.: M100-S121. Cornaglia, G., Giamarellou, H., et al. (2011). 'Metallo-[beta]-lactamases: a last frontier for [beta]-lactams?' The Lancet Infectious Diseases 11(5): 381-393. Cuzon, G., Naas, T., et al. (2008). 'Plasmid-mediated carbapenem-hydrolyzing beta-lactamase KPC-2 in Klebsiella pneumoniae isolate from Greece.' Antimicrob Agents Chemother 52(2): 796-797. Doumith, M., Ellington, M. J., et al. (2009). 'Molecular mechanisms disrupting porin expression in ertapenem-resistant Klebsiella and Enterobacter spp. clinical isolates from the UK.' J Antimicrob Chemother 63(4): 659-667. Frere, J. M., Galleni, M., et al. (2005). 'Is it necessary to change the classification of {beta}-lactamases?' J Antimicrob Chemother 55(6): 1051-1053. Haeggman, S., Lofdahl, S., et al. (1997). 'An allelic variant of the chromosomal gene for class A beta-lactamase K2, specific for Klebsiella pneumoniae, is the ancestor of SHV-1.' Antimicrob Agents Chemother 41(12): 2705-2709. Hanson, N. D., Hossain, A., et al. (2006). 'First occurrence of a Pseudomonas aeruginosa isolate in the United States producing an IMP metallo-beta-lactamase, IMP-18.' Antimicrob Agents Chemother 50(6): 2272-2273. Heritier, C., Dubouix, A., et al. (2005). 'A nosocomial outbreak of Acinetobacter baumannii isolates expressing the carbapenem-hydrolysing oxacillinase OXA-58.' J Antimicrob Chemother 55(1): 115-118. Heritier, C., Poirel, L., et al. (2005). 'Characterization of the naturally occurring oxacillinase of Acinetobacter baumannii.' Antimicrob Agents Chemother 49(10): 4174-4179. Institute., C. a. L. S. (2009). Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Strandard, Clinical and Laboratory Standards Institute (CLSI). Jacoby, G. A. (2009). 'AmpC {beta}-Lactamases.' Clin. Microbiol. Rev. 22(1): 161-182. Jeon, B. C., Jeong, S. H., et al. (2005). 'Investigation of a nosocomial outbreak of imipenem-resistant Acinetobacter baumannii producing the OXA-23 beta-lactamase in korea.' J Clin Microbiol 43(5): 2241-2245. Karthikeyan, K., Thirunarayan, M. A., et al. (2010). 'Coexistence of blaOXA-23 with blaNDM-1 and armA in clinical isolates of Acinetobacter baumannii from India.' Journal of Antimicrobial Chemotherapy 65(10): 2253-2254. Kiratisin, P., Apisarnthanarak, A., et al. (2008). 'Molecular characterization and epidemiology of extended-spectrum-beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates causing health care-associated infection in Thailand, where the CTX-M family is endemic.' Antimicrob Agents Chemother 52(8): 2818-2824. Kritsotakis, E. I., Tsioutis, C., et al. (2011). 'Antibiotic use and the risk of carbapenem-resistant extended-spectrum-β-lactamase-producing Klebsiella pneumoniae infection in hospitalized patients: results of a double case–control study.' Journal of Antimicrobial Chemotherapy 66(6): 1383-1391. Kumarasamy, K. K., Toleman, M. A., et al. (2010). 'Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study.' Lancet Infect Dis 10(9): 597-602. Lauretti, L., Riccio, M. L., et al. (1999). 'Cloning and characterization of blaVIM, a new integron-borne metallo-beta-lactamase gene from a Pseudomonas aeruginosa clinical isolate.' Antimicrob Agents Chemother 43(7): 1584-1590. Leavitt, A., Navon-Venezia, S., et al. (2007). 'Emergence of KPC-2 and KPC-3 in carbapenem-resistant Klebsiella pneumoniae strains in an Israeli hospital.' Antimicrob Agents Chemother 51(8): 3026-3029. Lee, C. H., Chu, C., et al. (2007). 'Collateral damage of flomoxef therapy: in vivo development of porin deficiency and acquisition of blaDHA-1 leading to ertapenem resistance in a clinical isolate of Klebsiella pneumoniae producing CTX-M-3 and SHV-5 beta-lactamases.' J Antimicrob Chemother 60(2): 410-413. Lee, K., Yong, D., et al. (2007). 'Reduced imipenem susceptibility in Klebsiella pneumoniae clinical isolates with plasmid-mediated CMY-2 and DHA-1 beta-lactamases co-mediated by porin loss.' Int J Antimicrob Agents 29(2): 201-206. Liu, S. Y., Lin, J. Y., et al. (2006). 'Integron-associated imipenem resistance in Acinetobacter baumannii isolated from a regional hospital in Taiwan.' Int J Antimicrob Agents 27(1): 81-84. Livermore, D. M. (2003). 'Bacterial resistance: origins, epidemiology, and impact.' Clin Infect Dis 36(Suppl 1): S11-23. Mammina, C., Palma, D. M., et al. (2010). 'Outbreak of infection with Klebsiella pneumoniae sequence type 258 producing Klebsiella pneumoniae Carbapenemase 3 in an intensive care unit in Italy.' J Clin Microbiol 48(4): 1506-1507. Mandell, G. L. (2000). Mandell, Douglas and Bennett's principles and practice of infectious diseases, Elsevier. Martinez-Martinez, L., Pascual, A., et al. (1999). 'Roles of beta -Lactamases and Porins in Activities of Carbapenems and Cephalosporins against Klebsiella pneumoniae.' Antimicrob. Agents Chemother. 43(7): 1669-1673. Miriagou, V., Tzouvelekis, L. S., et al. (2003). 'Imipenem resistance in a Salmonella clinical strain due to plasmid-mediated class A carbapenemase KPC-2.' Antimicrob Agents Chemother 47(4): 1297-1300. Murray, P. R. and Baron, E. J. (2007). Manual of clinical microbiology. Washington, D.C., ASM Press. Neonakis, I. K., Samonis, G., et al. (2010). 'Resistance status and evolution trends of Klebsiella pneumoniae isolates in a university hospital in Greece: ineffectiveness of carbapenems and increasing resistance to colistin.' Chemotherapy 56(6): 448-452. Park, Y.-J., Yu, J. K., et al. 'Prevalence and contributing factors of nonsusceptibility to imipenem or meropenem in extended-spectrum [beta]-lactamase-producing Klebsiella pneumoniae and Escherichia coli.' Diagnostic Microbiology and Infectious Disease In Press, Corrected Proof. Paterson, D. L. (2000). 'Recommendation for treatment of severe infections caused by Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs).' Clin Microbiol Infect 6(9): 460-463. Paterson, D. L. and Bonomo, R. A. (2005). 'Extended-spectrum beta-lactamases: a clinical update.' Clin Microbiol Rev 18(4): 657-686. Paton, R., Miles, R. S., et al. (1993). 'ARI 1: beta-lactamase-mediated imipenem resistance in Acinetobacter baumannii.' Int J Antimicrob Agents 2(2): 81-87. Philippon, A., Arlet, G., et al. (2002). 'Plasmid-determined AmpC-type beta-lactamases.' Antimicrob Agents Chemother 46(1): 1-11. Pitout, J. D. and Laupland, K. B. (2008). 'Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern.' Lancet Infect Dis 8(3): 159-166. Poirel, L., Heritier, C., et al. (2004). 'Emergence of oxacillinase-mediated resistance to imipenem in Klebsiella pneumoniae.' Antimicrob Agents Chemother 48(1): 15-22. Potron, A., Nordmann, P., et al. (2011). 'Characterization of OXA-181, a carbapenem-hydrolyzing class D {beta}-lactamase from Klebsiella pneumoniae.' Antimicrob Agents Chemother. Queenan, A. M. and Bush, K. (2007). 'Carbapenemases: the versatile beta-lactamases.' Clin Microbiol Rev 20(3): 440-458, table of contents. Riccio, M. L., Franceschini, N., et al. (2000). 'Characterization of the metallo-beta-lactamase determinant of Acinetobacter baumannii AC-54/97 reveals the existence of bla(IMP) allelic variants carried by gene cassettes of different phylogeny.' Antimicrob Agents Chemother 44(5): 1229-1235. Scaife, W., Young, H. K., et al. (1995). 'Transferable imipenem-resistance in Acinetobacter species from a clinical source.' J Antimicrob Chemother 36(3): 585-586. Schneider, I., Queenan, A. M., et al. (2006). 'Novel carbapenem-hydrolyzing oxacillinase OXA-62 from Pandoraea pnomenusa.' Antimicrob Agents Chemother 50(4): 1330-1335. Shu, J. C., Chia, J. H., et al. (2010). 'A 7-year surveillance for ESBL-producing Escherichia coli and Klebsiella pneumoniae at a university hospital in Taiwan: the increase of CTX-M-15 in the ICU.' Epidemiol Infect 138(2): 253-263. Skurnik, D., Lasocki, S., et al. (2010). 'Development of ertapenem resistance in a patient with mediastinitis caused by Klebsiella pneumoniae producing an extended-spectrum {beta}-lactamase.' J Med Microbiol 59(1): 115-119. Souli, M., Galani, I., et al. (2010). 'An outbreak of infection due to beta-Lactamase Klebsiella pneumoniae Carbapenemase 2-producing K. pneumoniae in a Greek University Hospital: molecular characterization, epidemiology, and outcomes.' Clin Infect Dis 50(3): 364-373. Taiwan, C. D. C. (2009). Nosocomial Infections Surveillance System, Centers for Disease Control. Turton, J. F., Kaufmann, M. E., et al. (2005). 'Detection and typing of integrons in epidemic strains of Acinetobacter baumannii found in the United Kingdom.' J Clin Microbiol 43(7): 3074-3082. Vahaboglu, H., Budak, F., et al. (2006). 'High prevalence of OXA-51-type class D beta-lactamases among ceftazidime-resistant clinical isolates of Acinetobacter spp.: co-existence with OXA-58 in multiple centres.' J Antimicrob Chemother 58(3): 537-542. Walther-Rasmussen, J. and Hoiby, N. (2004). 'Cefotaximases (CTX-M-ases), an expanding family of extended-spectrum β-lactamases.' Canadian Journal of Microbiology 50(3): 137-165. Walther-Rasmussen, J. and Hoiby, N. (2004). 'Cefotaximases (CTX-M-ases), an expanding family of extended-spectrum beta-lactamases.' Can J Microbiol 50(3): 137-165. Walther-Rasmussen, J. and Hoiby, N. (2006). 'OXA-type carbapenemases.' J Antimicrob Chemother 57(3): 373-383. Watanabe, M., Iyobe, S., et al. (1991). 'Transferable imipenem resistance in Pseudomonas aeruginosa.' Antimicrob Agents Chemother 35(1): 147-151. Woodford, N., Tierno, P. M., Jr., et al. (2004). 'Outbreak of Klebsiella pneumoniae Producing a New Carbapenem- Hydrolyzing Class A {beta}-Lactamase, KPC-3, in a New York Medical Center.' Antimicrob. Agents Chemother. 48(12): 4793-4799. Wu, H.-S., Chen, T.-L., et al. (2010). 'First Identification of a Patient Colonized With Klebsiella pneumoniae Carrying blaNDM-1 in Taiwan.' Journal of the Chinese Medical Association 73(11): 596-598. Wu, J. J., Wang, L. R., et al. (2011). 'Prevalence and characteristics of ertapenem-resistant Klebsiella pneumoniae isolates in a Taiwanese university hospital.' Microb Drug Resist 17(2): 259-266. Yamamoto, T., Takano, T., et al. (2011). 'Emergence of NDM-1-positive capsulated <i>Escherichia coli</i> with high resistance to serum killing in Japan.' Journal of Infection and Chemotherapy 17(3): 435-439. Yan, J.-J., Ko, W.-C., et al. (2001). 'Outbreak of Infection with Multidrug-Resistant Klebsiella pneumoniae Carrying blaIMP-8 in a University Medical Center in Taiwan.' J. Clin. Microbiol. 39(12): 4433-4439. Yan, J.-J., Ko, W.-C., et al. (2004). 'Complexity of Klebsiella pneumoniae Isolates Resistant to Both Cephamycins and Extended-Spectrum Cephalosporins at a Teaching Hospital in Taiwan.' J. Clin. Microbiol. 42(11): 5337-5340. Yan, J. J., Hsueh, P. R., et al. (2001). 'Metallo-beta-lactamases in clinical Pseudomonas isolates in Taiwan and identification of VIM-3, a novel variant of the VIM-2 enzyme.' Antimicrob Agents Chemother 45(8): 2224-2228. Yan, J. J., Ko, W. C., et al. (2002). 'Metallo-beta-lactamase-producing Enterobacteriaceae isolates in a university hospital in Taiwan: prevalence of IMP-8 in Enterobacter cloacae and first identification of VIM-2 in Citrobacter freundii.' J Antimicrob Chemother 50(4): 503-511. Yan, J. J., Ko, W. C., et al. (2002). 'Emergence of Klebsiella pneumoniae isolates producing inducible DHA-1 beta-lactamase in a university hospital in Taiwan.' J Clin Microbiol 40(9): 3121-3126. Yan, J. J., Ko, W. C., et al. (2000). 'Dissemination of CTX-M-3 and CMY-2 beta-lactamases among clinical isolates of Escherichia coli in southern Taiwan.' J Clin Microbiol 38(12): 4320-4325. Yan, J. J., Wu, J. J., et al. (2010). 'Prevalence and characteristics of ertapenem-nonsusceptible Escherichia coli in a Taiwanese university hospital, 1999 to 2007.' Eur J Clin Microbiol Infect Dis 29(11): 1417-1425. Yan, J. J., Wu, S. M., et al. (2000). 'Prevalence of SHV-12 among clinical isolates of Klebsiella pneumoniae producing extended-spectrum beta-lactamases and identification of a novel AmpC enzyme (CMY-8) in Southern Taiwan.' Antimicrob Agents Chemother 44(6): 1438-1442. Yang, D., Guo, Y., et al. (2009). 'Combined Porin Loss and Extended Spectrum β-Lactamase Production is Associated with an Increasing Imipenem Minimal Inhibitory Concentration in Clinical <i>Klebsiella pneumoniae</i> Strains.' Current Microbiology 58(4): 366-370. Yang, Y. J., Wu, P. J., et al. (1990). 'Biochemical characterization of a beta-lactamase that hydrolyzes penems and carbapenems from two Serratia marcescens isolates.' Antimicrob. Agents Chemother. 34(5): 755-758. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/66717 | - |
dc.description.abstract | 背景 廣泛抗藥性克雷伯氏肺炎桿菌是近年來各國關注的院內感染問題。碳青黴烯類抗生素是用來治療產超廣效性乙內醯胺分解酶腸內菌的嚴重感染症之首選抗生素,碳青黴烯類抗生素抗藥性的產生與擴散對臨床治療造成莫大的衝擊。近年在台灣臨床上分離出的克雷伯氏肺炎桿菌對碳青黴烯類不具感受性的情形似有逐漸上升的趨勢。因此,站在公共衛生的角度,偵測帶有碳青黴烯類抗生素抗藥基因的克雷伯氏肺炎桿菌,並了解使克雷伯氏肺炎桿菌對碳青黴烯類抗生素呈現抗藥性之危險因子是重要的議題。
材料與方法 我們對2007-2010年台大醫院臨床分離克雷伯氏肺炎桿菌菌株進行碳青黴烯類抗生素抗藥基因分子流行病學調查,針對58株於最小抑制濃度測試對碳青黴烯類抗生素表現不具感受性(MICERTA≥ 0.5mg/L)之克雷伯氏肺炎桿菌(ertapenem-non- susceptible K. pneumoniae)以聚合脢鏈反應方法檢測其是否帶有任何潛在的碳青黴烯類抗生素抗藥基因。對於僅帶有超廣效性乙內醯胺分解酶基因,未帶有碳青黴烯類抗生素抗藥基因但卻表現碳青黴烯類抗生素不具感受性的菌株(ESBL-producing ertapenem-non- susceptible K. pneumoniae),我們進一步以32株對碳青黴烯類抗生素具感受性之帶超廣效性乙內醯胺分解酶基因之克雷伯氏肺炎桿菌(ESBL-producing ertapenem-susceptible K. pneumoniae) 做為對照組,以病例對照研究設計探討病人特性、菌株於抗生素暴露的情形以及所帶有的乙內醯胺分解酶之基因型是否為使ESBL-producing ertapenem-susceptible菌株獲得碳青黴烯類抗生素抗藥性之危險因子。 結果 分子流行病學調查發現,在58株在最小抑制濃度測試對碳青黴烯類抗生素表現抗藥性之克雷伯氏肺炎桿菌中,偵測到8株(14%)具有碳青黴烯類抗生素抗藥基因,分別為blaIMP-8(n=1)、blaVIM-1(n=2)、blaOXA-23(n=3)、blaOXA-65(n=5)(部分菌株帶有兩種以上碳青黴烯類抗生素抗藥基因)。剩下的50株(86%)未偵測到任何碳青黴烯類抗生素抗藥基因,僅帶有多種超廣效性乙內醯胺分解酶之抗藥基因。病例對照研究結果顯示,調整干擾因子影響後,僅有一個顯著的危險因子會增加僅帶有超廣效性乙內醯胺分解酶基因型的克雷伯氏肺炎桿菌表現碳青黴烯類抗生素抗藥性之風險,為帶有blaCTX-M-14和blaDHA-1之複合基因型 (校正後的OR=21.8, p<0.001),其族群歸因比例為70.2%。另外,帶有blaCTX-M-14和blaDHA-1之任一基因的菌株於碳青黴烯類抗生素暴露之分層分析結果顯示,碳青黴烯類抗生素的暴露對於對僅帶有blaCTX-M-14和blaDHA-1基因型且對碳青黴烯類抗生素具感受性之克雷伯氏肺炎桿菌,會增加產生碳青黴烯類抗生素抗藥性之風險,且最小抑制濃度越高,產生抗藥性之風險越高。 結論 本研究首次在台灣的碳青黴烯類抗生素抗藥性克雷伯氏肺炎桿菌發現VIM型碳青黴烯類抗生素抗藥基因,以及OXA型碳青黴烯類抗生素抗藥基因blaOXA-23和blaOXA-65(過去僅在鮑氏不動桿菌報告過)。病例對照研究結果顯示,在公共衛生上若採取適當措施針對帶複合基因之菌株的散佈進行管控,可能可以減少70.2% 僅帶有超廣效性乙內醯胺分解酶基因但卻表現出碳青黴烯類抗生素不具感受性之克雷伯氏肺炎桿菌菌株(ESBL-producing ertapenem-non-susceptible)的浮現。 | zh_TW |
dc.description.abstract | Background Nosocomial infection caused by multi-drug resistant Klebsiella pneumoniae has become an important public health concern worldwide. Carbapenem-class antibiotics are the main therapeutic options for life-threatening infections caused by extended spectrum beta-lactamase (ESBL)-producing enteric bacteria. Emergence and dissemination of carbapenem resistance has a great impact on clinical treatment. In recent years, there has been an increasing trend of ertapenem-non-susceptible K. pneumoniae clinical isolates in Taiwan. From a public health viewpoint, it is important to detect the emergence and dissemination of carbapenemase genes in K. pneumoniae and to identify risk factors for the acquisition of carbapenem resistance.
Materials and Methods We conducted a molecular epidemiologic survey of carbapenemase genes among 2007–2010 clinical K. pneumoniae isolates at National Taiwan University Hospital. We used polymerase chain reaction to detect carbapenemase genes in 58 K. pneumoniae strains that are not susceptible to ertapenem by a minimal concentration inhibitory test (MICERTA≥ 0.5 mg/L). For ESBL gene-carrying K. pneumoniae strains that did not carry carbapenemase genes but still showed ertapenem-non-susceptible phenotype (ESBL-producing ertapenem-non-susceptible K. pneumoniae), we conducted an epidemic case-control study among 32 ESBL-producing ertapenem-susceptible K. pneumoniae strains (ESBL-producing ertapenem-susceptible) as the control to identify whether characteristics of patients, antibiotic exposure and β-lactamase genotypes of strains are risk factors for the acquisition of carbapenem resistance ESBL-producing ertapenem-susceptible K. pneumoniae. Results In our molecular epidemiology survey, we detected carbapenemase genes, blaIMP-8 (n=1), blaVIM-1 (n=2), blaOXA-23 (n=2), and blaOXA-65 (n=5) (some strains have ≥2 genes) in 8 (14%) out of 58 ertapenem-non-susceptible K. pneumoniae stains. The remaining 50 ertapenem-non-susceptible K. pneumoniae strains (86%), which did not carry any carbapenemase genes but did carry multiple ESBL genes, are ESBL-producing ertapenem- non-susceptible strains. The results of this epidemic case-control study showed that, after adjusting for the effects of other variables, carrying blaCTX-M-14 (adjusted OR=2.2, p=0.209), carrying blaDHA-1 (adjusted OR=10.6, p=0.008), and simultaneously carrying blaCTX-M-14 and blaDHA-1 (adjusted OR=21.8, p<0.001) are independent risk factors for acquisition of carbapenem resistance by ESBL-producing ertapenem-non-susceptible K. pneumoniae. The total population attributable fraction (PAFTotal) is 70.2%. If ESBL-producing ertapenem- susceptible K. pneumoniae carrying blaCTX-M-14 and/or blaDHA-1 are exposed to carbapenem antibiotics, the risk of acquiring carbapenem-resistance may increase. Conclusion This study is the first to describe the identification of VIM-type and OXA-type carbapenemase genes in K. pneumoniae in Taiwan (blaOXA-23 and blaOXA-65 previously reported only in Acinetobacter baumannii). The results of an epidemic case-control study suggest that, from a public health view point, appropriate control measures targeting strains simultaneously carrying blaCTX-M-14 and blaDHA-1 may reduce the incidence of ESBL-producing ertapenem-non-susceptible K. pneumoniae by 70.2%. Keywords: Klebsiella pneumoniae; Carbapenem; Resistance; Drug-Resistant Gene; Molecular Epidemiology; Risk Factor | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T00:53:15Z (GMT). No. of bitstreams: 1 ntu-100-R98842004-1.pdf: 6638326 bytes, checksum: 3636ae4ccdf49a82fad984dc5cdeeea4 (MD5) Previous issue date: 2011 | en |
dc.description.tableofcontents | 口試委員審定書 i
序言 ii 摘要 iii Abstract v Contents viii Table Contents x Figure Contents xii Chapter 1 Introduction 1 1.1 Background 1 1.2 Extended-Spectrum β-Lactamases (ESBLs) and AmpC β-Lactamases 3 1.3 Carbapenemases 4 1.4 The Effect of Carbapenem Use on Acquiring Carbapenem Resistance 10 1.5 Study Aim 11 Chapter 2 Materials and Methods 12 2.1 Setting, Bacterial Isolates and Susceptibility Test 12 2.2 Preparation of Bacteria, Resistant Genes Detection and Sequence Analysis 14 2.3 Study Design of Case-Control Study and Data Collection 15 2.4 Statistical Analysis 17 Chapter 3 Results 18 3.1 Molecular Epidemiology Survey of Resistant Genes 18 3.2 Risk Factors of Acquiring Carbapenemase Resistance 20 Chapter 4 Discussion 26 4.1. Carbapenemase Genes Distribution 26 4.2. Other Carbapenem-resistant Mechanisms in Our Ertapenem-Non-Susceptible strains 27 4.3. Carbepenem Use 29 4.4. Public Health Implications 30 4.5. Limitations 31 Acknowledgement 33 Reference 34 TABLEs 40 FIGUREs 56 Appendix 62 Table Contents TABLE 1. PRIMER SEQUENCES USED FOR DETECTING CARBAPENEMASES RESISTANT GENES 40 TABLE 2. PRIMER SEQUENCES USED FOR DETECTING OXAS, ESBLS, AND AMPC RESISTANT GENES 41 TABLE 3. POSITIVE NUMBER AND RATE OF ESBL, OXA-TYPE CARBAPENEMASE, AND CARBAPENEMASE RESISTANT GENES IN ERTAPENEM-NON-SUSCEPTIBLE K. PNEUMONIAE 42 TABLE 4. POSITIVE NUMBER AND RATE OF ESBL RESISTANT GENES IN ESBL-PRODUCING ERTAPENEM-SUSCEPTIBLE K. PNEUMONIAE 43 TABLE 5. CARBAPENEMASES, ESBL AND AMPC GENOTYPE AND MIC PROFILES OF ERTAPENEM-NON-SUSCEPTIBLE K. PNEUMONIAE 44 TABLE 6. ESBL AND AMPC GENOTYPE AND MIC PROFILES OF ESBL-PRODUCING ERTAPENEM-SUSCEPTIBLE K. PNEUMONIAE 46 TABLE 7. GENOTYPE PROFILES IN ERTAPENEM-NON-SUSCEPTIBLE AND ESBL-PRODUCING ERTAPENEM-SUSCEPTIBLE K. PNEUMONIAE 47 TABLE 8. CHARACTERISTIC DESCRIPTIONS OF THE EIGHT PATIENTS INFECTED BY THE ERTAPENEM-NON-SUSCEPTIBLE K. PNEUMONIAE CARRYING CARBAPENEMASES GENE. 48 TABLE 9. GENOTYPIC AND PHENOTYPIC RESULTS OF THE EIGHT K. PNEUMONIAE STRAINS CARRYING CARBAPENEMASES GENE ISOLATED FROM THE EIGHT PATIENTS. 49 TABLE 10. UNIVARIATE ANALYSIS OF RISK FACTORS FOR ACQUIRING CARBAPENEM RESISTANCE OF PATIENTS' CHARACTERISTICS 50 TABLE 11. UNIVARIATE ANALYSIS OF RISK FACTORS FOR ACQUIRING CARBAPENEM RESISTANCE OF ANTIBIOTICS EXPOSURE 51 TABLE 12. UNIVARIATE ANALYSIS OF RISK FACTORS FOR ACQUIRING CARBAPENEM RESISTANCE OF ESBL AND AMPC GENOTYPES 52 TABLE 13. MULTIPLE REGRESSION ANALYSIS OF CTX-M AND DHA GENOTYPES AS RISK FACTORS FOR ACQUIRING CARBAPENEM RESISTANCE 53 TABLE 14. MULTIPLE REGRESSION ANALYSIS FOR INDEPENDENT RISK FACTORS FOR ACQUIRING CARBAPENEM RESISTANCE 54 TABLE 15. STRATIFIED ANALYSIS OF CARBAPENEM EXPOSURE BY DIFFERENT ENTEROBACTERIACEAE RESISTANT MIC BREAKPOINTS 55 Figure Contents FIGURE 1. PERCENTAGE OF ESBL AND CARBAPENEMASE GENOTYPES IN ERTAPENEM-NON-SUSCEPTIBLE K. PNEUMONIAE 56 FIGURE 2. PERCENTAGE OF ESBL GENOTYPES IN ESBL-PRODUCING ERTAPENEM-SUSCEPTIBLE K. PNEUMONIAE 57 FIGURE 3. GEL ELECTROPHORESIS RESULT OF CARBAPENEMASES GENE DETECTION 58 FIGURE 4. NUMBER OF STRAINS ISOLATED FROM PATIENTS INFECTED BY K. PNEUMONIAE CARRYING CTX-M-14 + CTX-M-15 + DHA-1 GENOTYPE 59 FIGURE 5. PFGE PROFILES OF XBAI-DIGESTED GENOMIC DNA FROM THE 12 K. PNEUMONIAE CARRYING CTX-M-14 + CTX-M-15 + DHA-1 RESISTANT GENES 60 FIGURE 6. DENDROGRAM OF THE 12 K. PNEUMONIAE CARRYING CTX-M-14 + CTX-M-15 + DHA-1 RESISTANT GENES 61 | |
dc.language.iso | en | |
dc.title | 對碳青黴烯類抗生素具抗藥性之克雷伯氏肺炎桿菌分子流行病學調查及產生碳青黴烯類抗生素抗藥性之危險因子研究 | zh_TW |
dc.title | Molecular Epidemiology Survey of Carbapenem Resistant Klebsiella pneumoniae and Risk Factors of Acquiring Carbapenem Resistance | en |
dc.type | Thesis | |
dc.date.schoolyear | 100-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 李文宗(Wen-Chung Lee),薛博仁(Po-Ren Hsueh),施惟量(Wei-Liang Shih) | |
dc.subject.keyword | 克雷伯氏肺炎桿菌,碳青黴烯類抗生素,抗藥性,抗藥基因,分子流行病學,危險因子, | zh_TW |
dc.subject.keyword | Klebsiella pneumoniae,Carbapenem,Resistance,Drug-Resistant Gene,Molecular Epidemiology,Risk Factor, | en |
dc.relation.page | 81 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2011-10-20 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 流行病學與預防醫學研究所 | zh_TW |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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