調查分析雲林地區某區域教學醫院在2002及2003年培養出Klebsiella pneumoniae 院內總臨床分離菌株數分別為732及764株。其中會分泌超廣效乙內醯胺酶（ESBL-producing）之菌株分別為183（25.0%）及184 （24.1%）株，此盛行率遠高於文獻報告。為了探討該醫院ESBL-produing Klebsiella pneumoniae（ESBL-KP）菌株之抗生素感受性情況，並探討是否有特定菌株出現菌株散播（clonal spread）的現象而導致盛行率偏高。於2003年10月到2004年5月自該區域教學醫院共收集52株ESBL-KP臨床菌株，利用E-test測定下列抗生素：ampicillin，cephalothin，cefuroxime，cefotaxime，cefepime，ciprofloxacin，imipenem對ESBL-KP菌株的最低抑菌濃度；並利用脈衝式電泳，進行菌株之分子流行病學之分析。研究結果顯示，此52株ESBL-KP對ampicillin，cephalothin，cefuroxime，cefotaxime，cefepime，ciprofloxacin，imipenem 之MIC90（μg/ml）依次為 ³ 256，³ 256，³ 256，³ 256，32，³32，0.38μg/ml，此顯示即使是第四代頭孢芽菌素類抗生素，均不適合用以治療ESBL-KP所導致之感染；而ciprofloxacin僅對17株 （32.7 %）菌株有效，也突顯其臨床應用之局限性。至於imipenem，仍是對抗ESBL-KP最有效之抗生素。利用脈衝式電泳進行分子流行病學研究之結果，顯示有7株屬於type A，10株屬於type B，其餘35株，則屬於35個不同的脈衝式電泳型式。此結果說明在此區域教學醫院內，可能已有兩個ESBL-KP菌株有水平菌株散播之現象，往後可對type A、B菌株散播的能力，值得後續加以評估。 The prevalence rates of Extended-Spectrumβ-Lactamase-producing Klebsiella pneumoniae（ESBL-KP）among all nosocomial K. pneumoniae clinical isolates at the regional teaching hospital in Yun-Lin area were 25.0 % and 24.1% in 2002 and 2003, respectively. The prevalence rate was higher than those reported from other hospitals. The aim of this study was to investigate the drug susceptibility of these isolates and examine its capability of clonal spread among them. During October 2003 to May 2004, a total of nosocomial 52 clinical isolates of ESBL-KP collected at the regional teaching hospital was enrolled for further microbiologic study. Drug susceptibilities to ampicillin, cephalothin, cefuroxime, cefotaxime, cefepime, ciprofloxacin and imipenem were determined by minimum inhibitory concentration（MIC）using E-test and its molecular epidemiology was determined by pulsed-field gel electrophoresis（PFGE）. The results showed the MIC90 value of ampicillin, cephalothin, cefuroxime, and cefotaxime was ³ 256μg/ml, that of cefepime and ciprofloxacin was ³ 32μg/ml, and that of imipenem was 0.38μg/ml. Ciprofloxacin was only effective for 17 strains（32.7%）, indicating that ciprofloxacin was not an effective choice for treating ESBL-KP. Imipenem was still the most effective antibiotic to treat ESBL-KP. The molecular epidemiology determined by PFGE showed that there were 7 strains belong to type A, 10 strains belong to type B, and the other 35 strains belong to other different minor PFGE types. Isolates classified to type A or type B needed to closely examine its capability of clonal spread among isolates in the future.
