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台灣地區鮑氏不動桿菌分子分型資料庫及其整合子分子抗藥性機轉之研究. 在抗生素的不當使用之下，已造成抗藥性細菌快速演化並且大量的產生。近來，鮑氏不動桿菌（Acinetobacter baumannii）成為醫院中感染的重要病原菌之一。而具有多重抗藥性的A. baumannii（multidrug-resistant Acinetobacter baumannii; MDR-AB）更是台灣特有並常引起院內的突發性感染，在國內已陸續出現對第三線抗生素imipenem具抗藥性的菌株，是目前院內感染致病菌之中，最難以控制及治療的革蘭氏陰性菌之一。
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台灣地區鮑氏不動桿菌分子分型資料庫及其整合子分子抗藥性機轉之研究台灣地區鮑氏不動桿菌分子分型資料庫及其整合子分子抗藥性機轉之研究 在抗生素的不當使用之下，已造成抗藥性細菌快速演化並且大量的產生。近來，鮑氏不動桿菌（Acinetobacter baumannii）成為醫院中感染的重要病原菌之一。而具有多重抗藥性的A. baumannii（multidrug-resistant Acinetobacter baumannii; MDR-AB）更是台灣特有並常引起院內的突發性感染，在國內已陸續出現對第三線抗生素imipenem具抗藥性的菌株，是目前院內感染致病菌之中，最難以控制及治療的革蘭氏陰性菌之一。 如何快速並準確鑑定致病菌的類別與分型對於臨床及流行病學是最為迫切的。我們以ERIC PCR及REP PCR兩種分子指紋圖譜技術來進行細菌的分子分型，以完整的數位圖檔建立台灣地區鮑氏不動桿菌標準之分子分型資料庫。 除此，整合子（integron）是近年來被認為是細菌透過水平傳播以獲得新抗藥性基因及抗藥性基因散佈最重要的機制之一。整合子內之基因卡匣（gene cassettes）上可攜帶有各類型的抗藥基因，細菌經由integron主導基因卡匣透過進行特定部位重組作用的方式嵌入或移出integron，造成攜帶之抗藥性基因種類的改變和抗藥性基因的散佈，因此，integron在臨床菌株抗藥性之分佈扮演著重要角色。 廣效性乙內醯胺酶（Extended-spectrum β-lactamase；ESBL）已知對二、三代乙內醯胺具有較強的抗藥性，其中最具代表性的為TEM與SHV兩大類。因此本論文研究亦針對TEM和SHV兩組的基因序列，進行PCR分析，並探討其基因組成。 藉由上述ERIC PCR、REP PCR分子分型的結果、MIC資料庫、integron內抗藥性基因組成、TEM及SHV之變異等完整資料，進行各項比對分析，進而希望能發展出一套能夠提供臨床進行快速準確的菌種鑑別與治療方針的系統平台。
Molecular Fingerprinting Database Establishment of Acinetobacter baumannii in Taiwan and the Study of Antibiotic Resistance of Integron. • Because of the misuse in antibiotics administration, bacteria with drug resistance have been increased and transformed dramatically. Acinetobacter baumannii has become one of the most important clinical pathogens in these years. Recently multidrug-resistant A. baumannii (MDR-AB) has high occurrence involving in nosocomial outbreak in several Taiwan medical centers, and also been demonstrated to against the third generation β-lactam, such as imipenem. Therefore, A. baumannii now is recognized as one of the most difficult grem-negative bacteria to deal with in clinical treatment and epidemiology.Rapid and accurate methods to identify the bacterial species and genotype are the most critical issue in clinical treatment and epidemiological study. ERIC (Enterobacterial repetitive intergenic consensus sequence) and REP (repetitive extragenic palidromic sequence) PCR have demonstrated with excellent discriminative capability among bacterial pathogens, and were used for genotyping of A. baumannii to establish full database in our previous research.Many studies have shown that integron play an important role involving in the horizontal transfer of antibiotic resistance genes among different bacterial species. Gene cassette could carry large varieties of resistance genes within integron through site-specific recombination to move-in or move-out the integron. We first obtained full length of gene cassette through integron PCR, then analyzed each resistance gene using DNA sequencing and NCBI sequence blast.Extended-spectrum β-lactamase is the enzyme defined as the ability hydrolyze to the second-or third-generation of β-lactam antibiotics. Several common ESBL types are identified with highly occurring in variety of AB or MDR-AB strains such as TEM and SHV, this study can establish a standard platform for accurate bacterial identification system that may provides a novel treatment study to bacterial infection in clinical.
