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| ???org.dspace.app.webui.jsptag.ItemTag.dcfield??? | Value | Language |
|---|---|---|
| dc.contributor.advisor | 方啟泰(Chi-Tai Fang) | |
| dc.contributor.author | Ming-Chin Chan | en |
| dc.contributor.author | 詹明錦 | zh_TW |
| dc.date.accessioned | 2021-05-20T21:03:54Z | - |
| dc.date.available | 2012-10-03 | |
| dc.date.available | 2021-05-20T21:03:54Z | - |
| dc.date.copyright | 2011-10-03 | |
| dc.date.issued | 2010 | |
| dc.date.submitted | 2011-07-11 | |
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Inter-country transfer of Gram-negative organisms carrying the VIM-4 and OXA-58 carbapenem-hydrolysing enzymes. J Antimicrob Chemother 2006;57:794-5. 29. Turton JF, Ward ME, Woodford N, Kaufmann ME Pike R, Livermore DM, et al. The role of ISAba1 in expression of OXA carbapenemase genes in Acinetobacter baumannii. FEMS Microbiol Lett 2006 May;258:72-7. 30. Heritier C, Poirel L, Fournier PE, Claverie JM, Raoult D, Nordmann P. Characterization of the naturally occurring oxacillinase of Acinetobacter baumannii. Antimicrob Agents Chemother 2005;49:4174-9. 31. Heritier C, Poirel L, Lambert T, Nordmann P. Contribution of acquired carbapenem-hydrolyzing oxacillinases to carbapenem resistance in Acinetobacter baumannii. Antimicrob Agents Chemother 2005;49:3198-202. 32. Mazel D. Integrons: agents of bacterial evolution. Nat Rev Microbiol 2006;4:608-20. 33. Kraniotaki E, Manganelli R, Platsouka E, Grossato A, Paniara O, Palu G. 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In： Henrik Chart, editor.Methods in practical laboratory bacteriology. CRC Press, Boca Raton, Fla；1994：83-92. 43. Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233-9. 44. Park YS, Lee H, Lee KS, Hwang SS,Cho YK,Kim HY,et al. Extensively drug-resistant Acinetobacter baumannii: risk factors for acquisition and prevalent OXA-type carbapenemases--a multicentre study. Int J Antimicrob Agents 2010;36:430-5. 45. Pankey GA. Tigecycline. J Antimicrob Chemother 2005;56:470-80. 46. Chuang YC, Sheng WH, Li SY,Lin YC,Wang JT,Chen YC, et al. Influence of genospecies of Acinetobacter baumannii complex on clinical outcomes of patients with Acinetobacter bacteremia. Clin Infect Dis 2011;52:352-60. 47. Denton M, Wilcox MH, Parnell P, Green D, Keer V, Hawkey PM, et al. Role of environmental cleaning in controlling an outbreak of Acinetobacter baumannii on a neurosurgical intensive care unit. J Hosp Infect 2004;56:106-10. 48. Guh A, Carling, P. Options for Evaluating Environmental Cleaning. CDC http://www.cdc.gov/HAI/toolkits/Evaluating-Environmental-Cleaning.html, 2010. 49. Chang CY, Chang LL, Chang YH, Lee TM, Chang SF. Characterisation of drug resistance gene cassettes associated with class 1 integrons in clinical isolates of Escherichia coli from Taiwan, ROC. J Med Microbiol 2000;49:1097-102. 50. Koeleman JG, Stoof J, Van Der Bijl MW, Vandenbroucke-Grauls CM, Savelkoul PH. Identification of epidemic strains of Acinetobacter baumannii by integrase gene PCR. J Clin Microbiol 2001;39:8-13. 51. Brown S, Amyes S. OXA (beta)-lactamases in Acinetobacter: the story so far. J Antimicrob Chemother 2006;57:1-3. 52. Woodford N, Ellington MJ, Coelho JM,Turton JF,Ward ME,Brown S, et al. 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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/10126 | - |
| dc.description.abstract | Acinetobacter baumannii（鮑氏不動桿菌，簡稱 A. baumannii）抗藥性問題近年來在醫療照護相關感染防治上日益受到重視，依據Taiwan Nosocomial Infections Surveillance System(TNIS)統計資料顯示：醫學中心及區域醫院加護病房 carbapenem-resistant A. Baumannii 的比率從 2003 年不到 20%，逐年上升至 2010年第三季已達約 70%，本研究探討在某醫學中心自 2008 年到 2010年 (25個月) 期間，extensively drug-resisitant A. baumannii (XDRAB) 院內感染菌株的 Integron 抗藥性基因及 OXA(oxacillinases) typing 的分型情形，以了解其水解酵素種類及抗藥性機制，並以脈衝電泳分型（Pulsed-Field Gel Electrophoresis Analysis, PFGE）釐清院內 XDRAB 菌株間相關性，配合病例對照研究 (病例組：對照組=1︰4 配對) 探討 XDRAB 院內感染的危險因子。研究結果顯示 25 株 XDRAB 中有 23 株所帶的 Integron 均為 class I，且其所帶的 Gene cassette 大小皆為 2300 kb。所有 XDRAB 菌株都不帶有 class II Integron。在 OXA typing 的分型部份，可以看到大部分都帶有 OXA 23 (21株，84%) 和 OXA 51 (25株，100%)。所有 XDRAB 菌株經過 PFGE 分型鑑定後，以相似度為 80% 做切點可以分成14大類，並無單一顯著分子型別，在研究期間發生 XDRAB 院內群聚感染可能性相對較低，但是考量環境因素仍無法完全排除。病例對照研究結果為：在單變項分析中，長期臥床、血液透析、氣切、使用glycopeptide、使用imipenem or meropenem、使用 anti-Pseudomonal penicillins、使用第四代 cephalosporins 等均為發生 XDRAB 院內感染之顯著危險因子；以多變項 conditional logistic regression 調整干擾作用後，長期臥床（adjusted odds ratio 5.2, 95%CI: 1.1–24.4）及使用 imipenem、meropenem、anti- Pseudomonal penicillins、或第四代 cephalosporins（adjusted odds ratio 4.3, 95%CI: 1.4–12.7）兩變項均為發生 XDRAB 院內感染之獨立危險因子。本研究結論為：適當管制後線抗革蘭氏陰性菌抗生素的使用，為防治 XDRAB 院內感染不可或缺的一環。 | zh_TW |
| dc.description.abstract | The emergence of drug-resistant Acinetobacter baumannii (A. baumannii) is now a serious problem in healthcare-associated infections (HAIs) control. Data from Taiwan TINS showed that, while the percentage of carbapenem-resistant A. baumannii (CRAB) in ICU of medical centers/regional hospitals was less than 20% in 2003, it rose to 70% in Q3 2010. The objective of this study is to investage the distribution of integron drug-resistant gene and OXA typing of carbapenemase in extensively drug-resisitant A. baumannii (XDRAB) isolates from XDRAB-HAIs cases (2008~2010, 25 months). We also used pulsed-field gel electrophoresis (PFGE) to investigate the linkage between XDRAB strains. The risk factors of XDRAB-HAIs were investigated using case-control study (case: control=1:4). The result shows that 23 of 25 XDRAB isolates habored class I integron with a 2300-kb gene cassette. None carries class II integron. Most isolates had carry OXA 23 (n=21, 84%) and OXA51 (n=25, 100%). PFGE showed a genetic diversity among the 25 XDRAB isolates. Univariate analysis showed that long-term bed rest, hemodialysis, tracheostomy, use of glycopeptide, use of imipenem or meropenem, use of anti-pseudomonal penicillins, and use of the fourth generation cephalosporins, are statistically significant risk factors. Multiple conditional logistic regression analysis showed that, after adjusting for the effect of other variables, long-term bed rest (adjusted odds ratio 5.2, 95%CI: 1.1–24.4) and use of imipenem, meropenem, anti-pseudomonal penicillins, or the fourth-generation cephalosporins (adjusted odds ratio 4.3, 95%CI: 1.4–12.7) remain independent risk factors. We concluded that, for XDRAB HAIs control, it is essential to emphasize the prudent use of board-spectrum antibiotics active against gram-negative bacteria. | en |
| dc.description.provenance | Made available in DSpace on 2021-05-20T21:03:54Z (GMT). No. of bitstreams: 1 ntu-99-R98847019-1.pdf: 1559081 bytes, checksum: cce1a74511ef005934e757ab872fecb3 (MD5) Previous issue date: 2010 | en |
| dc.description.tableofcontents | 頁碼
目次………………………………………………………………………………. 2 圖表目錄…………………………………………………………………………. 4 中文摘要…………………………………………………………………………. 5 英文摘要…………………………………………………………………………. 6 第一章 緒論 一、廣泛抗藥性鮑氏不動桿菌簡介………………………………… 7 二、文獻回顧………………………………………………………… 8 三、研究目的…….………………………………………………..…. 12 四、實習單位特色與簡介……………………………………........... 13 第二章 方法 一、研究設計………………………………………………………… 16 二、方法與步驟……………………………………………………… 20 第三章 結果 如何完成目標與目的………………………………………………… 30 一、病例分析………………………………………………………… 31 二、抗生素藥物感受性試驗之結果………………………………… 31 三、XDRAB integrase、intregron gene cassette以及OXA typing PCR偵測結果................................................................................. 31 四、XDRAB菌株經PFGE分型之鑑定結果………………………… 32 五、危險因子之單一變項分析結果…………………………………. 32 六、危險因子之多變項分析結果……………………………………. 33 第四章 討論 一、國內醫院與實習單位之抗藥性A. baumannii院內感染率之比較 35 二、感染病例感染部位分布之討論…………………………………. 35 三、感染病例抗藥性基因Integron及OXA typing與國內其他資料 之比較…………………………………………………………… 35 四、PFGE電泳分型結果之意義……………………………………… 36 五、增加感染風險之危險因子探討…………………………………. 37 第五章 結論……………………………………………………………………… 41 附件一、醫療照護相關感染監測定義…………………………………………… 55 參考文獻………………………………………………………………………….. 71 | |
| dc.language.iso | zh-TW | |
| dc.title | 廣泛抗藥性鮑氏不動桿菌抗藥性機轉及院內感染危險因子 | zh_TW |
| dc.title | Drug Resistance Mechanism of Extensively Drug-resistant Acinetobacter baumannii (XDRAB) and Risk Factors of Healthcare-associated XDRAB Infections | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 99-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 王志堅(Chih-Chien Wang),薛博仁(Po-Ren Hsueh) | |
| dc.subject.keyword | 廣泛抗藥性鮑氏不動桿菌,脈衝電泳分型,病例對照研究, | zh_TW |
| dc.subject.keyword | extensively drug-resisitant A. baumannii,Pulsed-Field Gel Electrophoresis Analysis,case-control study, | en |
| dc.relation.page | 77 | |
| dc.rights.note | 同意授權(全球公開) | |
| dc.date.accepted | 2011-07-11 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 公共衛生碩士學位學程 | zh_TW |
| Appears in Collections: | 公共衛生碩士學位學程 | |
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