|摘要: ||抗藥性鮑氏不動桿菌( Acinetobacter baumannii)是引起醫療照護相關感染非常重要的原因，除高致病性與致死率外，也是醫療照護相關感染主要病原菌之ㄧ，而Integron是除了質體與轉位子之外，細菌獲得新抗藥基因有關的水平傳播單位。本研究在2008~2010年共收集彰化秀傳醫院100株鮑氏不動桿菌臨床血液培養菌株，針對14種抗生素進行抗藥性的測試。並運用CS-PCR技術來分析Class 1 integrons的分布與其所攜帶抗藥基因卡匣種類。分析後發現，鮑氏不動桿菌對cephalosporins類藥物的抗藥性明顯上升(由54%上升為66%)，且對PIP、TZP、SXT、SAM類抗生素的抗藥性也都有上升的趨勢，但同時發現對Aminoglycosides的抗藥性則有下降的趨勢(由60%降為48%)。|
約有61.8％的鮑氏不動桿菌臨床分離株可增幅出Class 1 integron的cassette array；增幅出的cassette array有3.0 kb, 2.5 kb, 1.5 kb和1.0 kb四種大小，其中以帶有2.5 kb cassette array所佔的比率最高，為所有帶integron的菌株之87.3%。經對照抗生素的抗性測試可以發現，帶有Class 1 integron的菌株，其具有的抗生素抗性比不具有Class 1 integron的菌株較為多樣化。可是發現頻率最高的2.5 kb的cassette array，在其他國家的報告卻極少；推測可能因素為經由醫院內長期抗生素壓力的篩選，使得帶有2.5 kb integron的鮑氏不動桿菌，形成了台灣地區特有的臨床優勢菌株，而這種趨勢的產生應該是與醫師在治療上使用的抗生素有關。
Antibiotics-resisant Acinetobacter baumannii is a very important cause of healthcare-associated infections, in addition to the highly pathogenic and mortality, it is one of major healthcare-associated infecting pathogens. Integrons are the genetic unit that confer antibiotic resistance to bacteria besides plasmid and transposon.In this study, 100 A. baumannii clinical blood culture isolates were collected from Show Chwan Memorial Hospital from 2008 to 2010 .When their drug susceptibility against 14 kinds of antibiotics were tested,it was found that the drug resistance of A. baumannii to cephalosporins increased significantly (54% up to 66%), and the resistance to PIP, TZP, SXT, SAM also have an upward trend , but the drug resistance to aminoglycosides decreased (60% down to 48%).
The CS-PCR method was used to detect the existence of class 1 integron , in these isolates. It was found that 61.8% of these isolates carried the class 1 integron, and the cassette arrays they carried were only in 4 different sizes: 3.0 kb, 2.5 kb, 1.5 kb and 1.0 kb,among them the isolates carrying 2.5 kb cassette array were at the highest percentage, 87.3%.This study also showed that A. baumannii isolates carrying integron were more resistant to various antibiotics tested than non-integron-carrying isolates. The widespread occurrence of 2.5 kb cassette array in A. baumannii isolates from Show Chwan Memorial Hospital was rarely reported in other countries.It is speculating that this phenomenon may be linked to the preference of hospital to certain particular antibiotics, so that the A. baumannii strains carrying 2.5-kb cassette array became dominant under antibiotic selection pressure.