Responsive image
博碩士論文 etd-0825103-162645 詳細資訊
Title page for etd-0825103-162645
論文名稱
Title
社區感染與院內感染金黃色葡萄球菌菌血症病患鼻腔菌株之分子流行病學
Molecular epidemiology of nasal carriage in patients with both community and hospital acquired Staphylococcus aureus bacteremia
系所名稱
Department
畢業學年期
Year, semester
語文別
Language
學位類別
Degree
頁數
Number of pages
55
研究生
Author
指導教授
Advisor
召集委員
Convenor
口試委員
Advisory Committee
口試日期
Date of Exam
2003-06-22
繳交日期
Date of Submission
2003-08-25
關鍵字
Keywords
院內感染、社區感染、金黃色葡萄球菌、脈衝式電泳
hospial-acquired infection, pulsed-field gel electrophoresis, Staphylococcus aureus, MRSA, community-acquired infection
統計
Statistics
本論文已被瀏覽 5726 次,被下載 0
The thesis/dissertation has been browsed 5726 times, has been downloaded 0 times.
中文摘要
金黃色葡萄球菌為社區及醫院內部主要的院內感染菌株之一,故本研究第一部分係針對高雄榮民總醫院2000年8月1日起至 2001年7月31日止,金黃色葡萄球菌菌血症患者之鼻腔及血液分離菌株,經SmaⅠ限制酶剪切染色體DNA後以脈衝式凝膠電泳法(Pulsed-field gel electrophoresis)進行基因分型。研究結果顯示在95位同時取得鼻腔及血液分離菌株的菌血症患者,有78位(82.1%)的菌株基因型各自相同;若再細分,則其中院內感染患者基因型相同比例是89.7%,社區型感染患者基因型相同比例則為62.5%,這個結果為推測同一患者鼻腔與血液菌株間有密切相關性的假設提供了有力證據;此外值得注意的是,此95位患者的菌株若配合扼塞青黴素藥性篩檢,院內感染抗扼塞青黴素金黃色葡萄球菌(MRSA)的比例達85.3%,而社區型感染MRSA的比例為 31.3%。第二部分研究針對此一年期間院內感染金黃色葡萄球菌菌血症患者的血液分離菌株進行脈衝式電泳分型分析, 163株菌株中最多的type A有84株(51.5%),分屬7種subtypes;次多的type B有10株(6.1%),3種subtypes。證明已有一流行的金黃色葡萄球菌菌株(type A,>50%)在院內水平傳播。這些結果提供支持應採行更強有力的院內感染控制措施;以及採取清除鼻腔金黃色葡萄球菌帶菌以避免引起全身性之感染。
Abstract
Staphylococcus aureus is one of the most important pathogens both in community- or hospital-acquired infections. The first part of this study analyzed the similarity of molecular types of S. aureus isolates cultured from nares and blood in patients with S. aureus bacteremia (SAB) by pulse-fielded gel electrophoresis (PFGE) of digested chromosomal DNA by Sma I at Kaohsiung Veterans General Hospital from August 1, 2000 through July 31, 2001. The results showed that the PFGE types of 78 (82.1%) paired nare and blood isolates of the 95 SAB patients having nasal carriage of S. aureus were clonally identical; identical in 89.7% patients of nosocomial group and 62.9% in community-acquired group. This provides the powerful evidence in close relationship between nasal carriage of S. aureus and acquisition of it in bacteremia. The data also showed that the rate of methicillin resistance occurred in SAB patients with nasal carriage in isolates of nosocomial SAB was 85.3%, and 31.3% in community-acquired group. The second part of this study analyzed the distribution of PFGE types of 163 nosocomial SAB isolates. The most predominant type was type A and composed 51.5% (84 strains) of 163 nosocomial SAB isolates. They were further divided into 7 subtypes. The second prevailing type was type B, 6.1%(10 strains). The evidence that an endemic stain (type A) occurred in >50% of nosocomial bacteremic isolates demonstrates horizontal dissemination of a single endemic strain of S. aureus in the SAB patients was common in the hospital. These results provide support for strategies to endorse more intensive procedures in infection control and to prevent systemic S. aureus infections by eliminating S. aureus nasal carriage.
目次 Table of Contents
中文摘要····································i
英文摘要····································iii
表 目錄····································v
圖 目錄····································vi
第一章 前言······························1
第二章 文獻回顧··························7
第三章 材料與方法························11
第四章 結果······························19
第五章 討論······························23
第六章 結論······························30
第七章 參考文獻··························31
圖表········································44
參考文獻 References
1. Abramson MA, Sextone DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999; 20:408-411.
2. Akram J, Glatt AE. True community-acquired methicillin-resistant Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol 1998; 19:106-107.
3. Anonymous. National nosocomial infections surveillance (NNIS) system report, data summary from January 1990-May 1999, issued June 1999. Am J Infect Control 1999; 27:520-532.
4. Bannerman TL, Hancock GA, Tenover FC, Miller JM. Pulsed-field gel electrophoresis as a replacement for bacteriophage typing of Staphylococcus aureus. J Clin Microbiol 1995; 33:551-555.
5. Bennett JV, Brachman PS. 1998. Hospital Infections, p.100. 4th ed. Lippincott-Raven Publishers, Philadelphia.
6. Bennett SN, McNeil MM, Bland LA, Arduino MJ, Villarino ME, Perrotta DM, Burwen DR, Welbel SF, Pegues DA, Stroud L, Zeitz PS, Jarvis WR. Postoperative infections traced to contamination of an intravenous anesthetic, propofol. N Engl J Med 1995; 333:147-154.
7. Black JG. 1996. Microbiology:principles & applications, p.422. 3rd ed. Prentice Hall, New Jersey.
8. Blot SI, Vandewoude KH, Hoste EA, Colardyn FA. Outcome and attributable mortality in critically ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus.
Arch Intern Med 2002; 162:2229-2235.
9. Boelaert JR, Van Landuyt HW, Godard CA. Nasal mupirocin ointment decreases the incidence of Staphylococcus aureus bacteremias in haemodialysis patients. Nephrol Dial Transplant 1993; 8:235-239.
10. Bonfiglio G, Carciotto V, Russo G, Stefani S, Schito GC, Debbia E, Nicoletti G. Antibiotic resistance in Pseudomonas aeruginosa: an Italian survey. J Antimicrob Chemother 1998; 41:307-310.
11. Boyce JM. Increasing prevalence of methicillin resistant Staphylococcus aureus in United States. Infect Control Hosp Epidemiol 1990; 11:639-642.
12. Boyce JM. Methicillin-resistant Staphylococcus aureus in hospitals and long-term care facilities: microbiology, epidemiology, and preventive measures. Infect Control Hosp Epidemiol 1992; 13:725-737.
13. Boyce JM, Opal SM, Chow JW, Zervos MJ, Potter-Bynoe G, Sherman CB, Romulo RL, Fortna S, Medeiros AA. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994; 32:1148-1153.
14. Boyce JM, Potter-Bynoe G, Dziobek L. Hospital reimbursement patterns with surgical wound infections following open heart surgery. Infect Control Hosp Epidemiol 1990; 11:89-93.
15. Boyce JM, White RL, Causey WA. Burn units as a source of methicillin- resistant Staphylococcus aureus infections. J Am Med Assoc 1983; 249: 2803-2807.
16. Brakstad OG, Aasbakk K, Maeland JA. Detection of Staphylococcus aureus by polymerase chain reaction amplification of the nuc gene. J Clin Microbiol 1992; 30:1654-1660.
17. Chen ML, Ho SC, Pan HJ. Longitudinal analysis of methicillin- resistant Staphylococcus aureus isolates at a Teching hospital in Taiwan. J Formos Med Assoc 1998; 426-432.
18. Casewell MW, Hill RL. The carrier state: methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother 1986; 18:Suppl A: 1-12.
19. Chow JW, Yu VL. Staphylococcus aureus nasal carriage in hemodialysis patients: its role in infection and approaches to prophylaxis. Arch Intern Med 1989; 149:1258-1262.
20. Coello R, Jimenez J, Garcia M. Prospective study of infection, colonization and carriage of methicillin-resistant Staphylococcus aureus in an outbreak affecting 900 patients. Eur J Clin microbial Infect Dis 1994; 13:74-81.
21. Cohen SH, Morita MM, Bradford M. A sevsn-year experience with methicillin-resistant Staphylococcus aureus. Am J Med.1991; 91:Suppl 3B: S233-237.
22. Cox RA, Conquest C, Mallaghan C, and Marples RR. A major outbreak of methicillin-resistant Staphylococcus aureus caused by a new phage-type (EMRSA-16). J Hosp Infect 1995; 29:87-106.
23. De Lencastre H, Santos I, Mole-Cristino J. Methicillin-resistant Staphylococcus aureus disease in a Portuguese hospital: characterization of clonal types by a combination of DNA typing methods. Eur J. Microbial Infect Dis 13:64-73.
24. Diekema DJ, Pfaller MA, Schmitz FJ, Smayevsky, Jones RN, Beach ML, SENTRY participants group. Survey of infections due to Staphylococcus species; frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Lating America, Europe, and the western Pacific region for the SENTRY antimicrobial surveillance rrogram, 1997-1999. Clin infect Dis 2001; 32:Suppl 2:S114-132.
25. Dominguez MA, De Lencastre H, Linares J, Tomasz A. Spread and maintenance of a dominant methicillin-resistant Staphylococcus aureus (MRSA) clone during an outbreak of MRSA disease in a Spanish hospital. J Clin Microbiol 1994; 32:2081-2087.
26. Fitzgerald JR, Sturdevant DE, Mackie SM. Evolutionary genomics of Staphylococcus aureus: insights into the origin of methicillin-resistant strains and the toxic shock syndrome epidemic. Proc. Natl. Acad. Sci. USA 2001; 98:8821-8826.
27. Gottlieb RD, Shah MK, Perlman DC, Kimmelman CP. Community- acquired methicillin-resistant Staphylococcus infections in otolaryngology. Otolaryngol Head Neck Surg 1992; 434-437.
28. Groom AV, Wolsey DH, Naimi TS, Smith K, Johnson S, Boxrud D, Moore KA, and Cheek JE. Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community. J Am Med Assoc 2001; 286:1201-1205.
29. Hemming VG, Overall JC, Britt MR. Nosocomial infections in a newborn intensive-care unit. Results of forty-one months of surveillance. N Engl J Med 1976; 294:1310-1316.
30. Herold BC, Immergluck LC, Maranan MC, Lauderdale DS, Gaskin RE, Boyle-Vavra S, Leitch CD, Daum RS. Community-acquired methicillin- resistant Staphylococcus aureus in children with no identified predisposing risk. J Am Med Assoc 1998; 279:593-598.
31. Holton DL, Nicolle LE, Diley D, Bernstein K. Efficacy of mupirocin nasal ointment in eradicating Staphylococcus aureus nasal carriage in chronic haemodialysis patients. J Hosp Infect 1991; 17:133-137.
32. Huang AH, Yan JJ, Wu JJ. Rapid dissemination of Staphylococcus aureus with classic oxacillin resistance phenotype at a new university hospital. J Hosp Infect 2000; 44:309-315.
33. Hussain FM, Boyle-vavra S, Daum RS. Community-acquired methicillin- resistant Staphylococcus aureus colonization in healthy children attending an outpatient pediatric clinic. Pediatric Infect Dis J 2001; 20:763-767.
34. Jawetz E, Melnick LJ, Adelberg EA. Medical microbiology, p414, 18th ed. appleton & lange, USA, 1989.
35. Katayama Y, Ito T, Hiramatsu K. A new class of genetic element, Staphylococcus cassette chromosome mec, encodes methicillin resistance in Staphylococcus aureus. Antimicrob Agents Chemother 2000; 44:1549-1555.
36. Kauffman CA, Terpenning MS, He X, Zarins LT, Ramsey MA, Jorgensen KA, Sottile WS, Bradley SF. Attempts to eradicate methicillin- resistant Staphylococcus aureus from a long-term- care facility with the use of mupirocin ointment. Am J Med 1993; 94:371-378.
37. Kluytmans JA, Mouton JW, Ijzerman EP, et al. Nasal carriage of Staphylococcus aureus as a major risk factor for wound infections after cardiac surgery. J Infect Dis 1995; 171:216-219.
38. Kluytmans JA, van Belkum A, Verbrugh H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997; 10:505-520.
39. Laupland KB, Zygun DA, Davies HD, Church DL, Louie TJ, Doig CJ. Population-based assessment of intensive care unit-acquired bloodstream infections in adults: Incidence, risk factors, and associated mortality rate. Critical Care Med 2002; 30:2462-2467.
40. Levine DP, Cushing RD, Jui J, Brown WJ. Community-acquired methicillin-resistant Staphylococcus aureus endocarditis in the Detroit medicine center. Ann Intern Med 1982; 97:330-338.
41. Lowy FD. Antimicrobial resistance: the example of Staphylococcus aureus. J Clin Invest 2003; 111:1265-1273.
42. Luzar MA, Coles GA, Faller B, Slingeneyer A, Dah GD, Briat C, Wone C, Knefati Y, Kessler M, Peluso F. Staphylococcus aureus nasal carriage and infection in patients on continuous ambulatory peritoneal dialysis. N Engl J Med 1990; 322:505-509.
43. Martineau F, Picard FJ, Roy PH, Ouellette M, and Bergeron M G. Species- specific and ubiquitous- DNA-based assays for rapid identification of Staphylococcus aureus. J Clin Microbiol 1998; 36:618-623.
44. Matushek MG., Bonten MJ, Hayden MK. Rapid preparation of bacterial DNA for pulsed-field gel electrophoresis. J Clin Microbiol 1996; 34:2598-2600.
45. Merlino J, Leroi M, Bradbury R, Veal D, Harbour C. New chromogenic identification and detection of Staphylococcus aureus and methicillin- resistant S. aureus. J Clin Microbiol 2000; 38:2378-2380.
46. Montecalvo MA, Horowitz H, Gedris C, Carbonaro C, Tenover FC, Issah A, Cook P, Wormser GP. Outbreak of vancomycin-, ampicillin-, and aminoglycoside-resistant Enterococcus faecium bacteremia in an adult oncology unit. Antimicrob Agents Chemother 1994; 38:1363-1367.
47. Moreno F, Grota P, Crisp C, Magnon K, Melcher GP, Jorgensen JH, Patterson JE. Clinical and molecular epidemiology of vancomycin-resistant Enterococcus faecium during its emergence in a city in southern Texas. Clin Infect Dis 1995; 21:1234-1237.
48. Mulligan ME, Murray-Leisure KA, Ribner BS, Standiford HC, John JF, Korvick JA, Kauffman CA, Yu VL. Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993; 94:313-328.
49. Noble WC, Rahman M, Cookson B, Phillips I. Transferable mupirocin- resistance. J Antimicrob Chemother 1988; 22:771b-772b.
50. Oliveira DC, Wu SW, Lencastre HD. Genetic organization of the downstream region of the mecA element in methicillin-resistant Staphylococcus aureus isolates carrying different polymorphisms of this region. Antimicrob Agents Chemother 2000; 44:1906-1910.
51. Perl TM, Cullen JJ, Wenzel RP, Zimmerman MB, Pfaller MA, Sheppard D, Twombley J, French PP, Herwaldt LA. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 2002; 346:1871-1877.
52. Pfaller MA. Jones RN. Doern GV. Kugler K. Bacterial pathogens isolated from patients with bloodstream infection: frequencies of occurrence and antimicrobial susceptibility patterns from the SENTRY antimicrobial surveillance program (United States and Canada, 1997). Antimicrob Agents Chemother 1998; 42:1762-1770.
53. Roman RS, Smith J, Walker M, Byrne S, Ramotar K, Dyck B, Kabani A, Nicolle LE. Rapid geographic spread of a methicillin-resistant Staphylococcus aureus strain. Clin Infect Dis 1997; 25:698-705.
54. Rubin LG, Tucci V, Cercenado E, Eliopoulos G, Isenberg HD. Vancomycin-resistant Enterococcus faecium in hospitalized children. Infect Control Hosp Epidemiol 1992; 13:700-705.
55. Ryefel C, Bucher R, Kayser FH. The Staphylococcus aureus mec determinant comparises an unusual cluster of direct repeats and codes for gene product similar to Escherichia coli sn- glycerophosphoryl diester phosphodiesterase. J Bacteriol 1991; 173:7146-7422.
56. Sanches IS, Ramirez M, Troni H, Abecassis M, Padua M, Tomasz A, de Lencastre H. Evidence for the geographic spread of a methicillin-resistant Staphylococcus aureus clone between Portugal and Spain. J Clin Microbiol 1995; 33:1243-1246.
57. Sanford MD, Widmer AF, Bale MJ, Jones RN, Wenzel RP. Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1994; 19:1123-1128.
58. Saulnier P, Bourneix C, Prevost G, Andremont A. Random amplified polymorphic DNA assay is less discriminant than pulsed- field gel electrophoresis for typing strains of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 1993; 31:982-985.
59. Schlichting C, Branger C, Fournier JM. Typing of Staphylococcus aureus by pulsed-field gel electrophoresis, zymotyping, capsular typing, and phage typing: resolution of clonal relationships. J Clin Microbiol 1993; 31:227-232.
60. Senna JPM, Pinto CA, Carvalho LPS, and Santos DS. Comparison of pulsed- field gel electrophoresis and PCR analysis of polymorphisms on the mec hypervariable region for typing methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2002; 40:2254-2256.
61. Sewell CM, Clarridge J, Lacke C, Weinman EJ, Young EJ. Staphylococcal nasal carriage and subsequent infection in peritoneal dialysis patients. J Am Med Assoc 1982; 248:1493-1495.
62. Sieradzki K, Roberts RB, Haber SW, Tomasz A. Brief Report: The development of vancomycin resistance in a patient with methicillin-resistant Staphylococcus aureus infection. N Engl J Med 1999; 340:517-523.
63. Simpson AE, Skurray RA, Firth N. An IS257-derived hybrid promoter directs transcription of a tetA(K) tetracycline resistance gene in the Staphylococcus aureus chromosomal mec region. J Bacteriol 2000; 182:3345-3352.
64. Smith TL, Pearson ML, Wilcox KR, Cruz C, Lancaster MV, Robinson-Dunn B, Tenover FC, Zervos MJ, Band JD, White E, Jarvis WR. Emergence of vancomycin resistance in Staphylococcus aureus. N Engl J Med 1999; 340:493-501.
65. Steinberg JP, Clark CC, Hackman BO. Nosocomial and community- acquired Staphylococcus aureus bacteremias from 1980 to 1993: impact of intravascular devices and methicillin resistance. Clin Infect Dis 1996; 23:255-259.
66. Tenover FC, Arbeit R, Archer G. Comparison of traditional and molecular methods of typing isolates of Staphylococcus aureus. J Clin Microbiol 1994; 32:407-415.
67. Van Belkum A, Van Leeuwen W, Verkooyen R, Sacilik SC, Cokmus C, Verbrugh H. Dissemination of a single clone of methicillin-resistant Staphylococcus aureus among Turkish hospitals. J Clin Microbiol 1997; 35:978-981.
68. von Eiff C. Becker K. Machka K. Stammer H. Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 2001; 344:11-16.
69. Wang JT, Chen YC, Yang TL, Chung SC. Molecular epidemiology and antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus in Taiwan. Diag Microbiol Infect Dis 2002; 42:199-203.
70. Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, Reller LB. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997; 24:584-602.
71. Weller TMA. Methicillin-resistant Staphylococcus aureus typing methods: which should be the international standard? J Hosp Infect 2000; 44:160-172.
72. Wenzel RP, Perl TM. The significance of nasal carriage of Staphylococcus aureus and the incidence of postoperative wound infection. J Hosp Infect 1995; 31:13-24.
73. Wildemauwe C, Godard C, Vanhood R, Van Bossuyt E, Hannecart-Pokorni E. Changes in major populations of methicillin- resistant Staphylococcus aureus in Belgium. J Hosp Infect 1996; 34:197-203.
74. Williams REO. Healthy carriage of Staphylococcus aureus: its prevalence and importance. Bacteriol Rev 1963; 27:56-71.
75. Yu VL, Goetz A, Wagener M, Smith PB, Rihs JD, Hanchett J, Zuravleff JJ. Staphylococcus aureus nasal carriage and infection in patients on hemodialysis: efficacy of antibiotic prophylaxis. N Engl J Med 1986; 315:91-96.
電子全文 Fulltext
本電子全文僅授權使用者為學術研究之目的,進行個人非營利性質之檢索、閱讀、列印。請遵守中華民國著作權法之相關規定,切勿任意重製、散佈、改作、轉貼、播送,以免觸法。
論文使用權限 Thesis access permission:校內校外均不公開 not available
開放時間 Available:
校內 Campus:永不公開 not available
校外 Off-campus:永不公開 not available

您的 IP(校外) 位址是 34.228.43.90
論文開放下載的時間是 校外不公開

Your IP address is 34.228.43.90
This thesis will be available to you on Indicate off-campus access is not available.

紙本論文 Printed copies
紙本論文的公開資訊在102學年度以後相對較為完整。如果需要查詢101學年度以前的紙本論文公開資訊,請聯繫圖資處紙本論文服務櫃台。如有不便之處敬請見諒。
開放時間 available 已公開 available

QR Code