探討 Acinetobacter baumannii 抗性圖譜與oxa 23 抗性基因的相關性

Acinetobacter baumannii 為常見的環境微生物，也是人類皮膚與黏膜上的正常菌叢之一，但卻常使免疫功能缺損患者罹患許多嚴重感染疾病，如肺炎、尿道炎、心內膜炎、傷口感染、腦膜炎與敗血病等等。A. baumannii更為醫院中造成院內感染常見的菌株，近年來，更由於臨床上抗生素的使用頻繁，形成了多重抗藥菌株，造成治療上的困難，目前，醫界對於A. baumanni 的感染及其抗性問題已經愈來愈重視了。過去的研究發現：曾發現A. baumannii的抗性基因種類非常多，且發生的比例在各個國家都不盡相同。本研究以中山醫學大學附設醫院中100株A. baumannii臨床菌株為基礎，根據A. baumannii抗性圖譜來探討與抗性基因的相關性。在這100株A. baumannii 中，進行抗生素紙錠試驗測定對抗生素的敏感性，隨即以聚合酶連鎖反應(PCR)方法進行抗藥性基因的研究，結果發現 具b-lactam 抗性的菌株，有87% 具有ARI-1 (OXA 23) 基因；且不具OXA 23 基因的菌株，也有高達86 %對多數 b-lactam藥物呈敏感性，因此，我們最後的結論認為：OXA 23 基因和 b-lactam的抗性是有很大的關係。近年來台灣 A. baumannii的臨床菌株之抗藥性已日趨嚴重，期望未來利用抗性基因的偵測，可提早做為臨床抗生素用藥的參考。

Acinetobacter baumanni are often seen of environment microorganism, and also in the skin and mucous membrane of human, but can cause serious infection disease if the patients are immunodeficiency, such as pneumonia、urinary-tract infection, endocarditis, a wound infection, meningitis and septicemia. A. baumanni are often cause nosocomial infection, in recent years, because using antibiotics are frequently, A. baumanni become to muti-drug resistant, and difficult to treatment. Now, A. baumanni infection and resistant problem are important and significant. In the past study, A. baumannii have many kinds of genotype, and the ratio was different in every countries. This study, we collected 100 of A. baumanni from Chung Shan Medical University Hospital. In this study objective, we base on the antibiogram of A. baumanni , and hope the find the correlation of the antibiogrm and genotype of A. baumanni. In these 100 A. baumannii , we use disk susceptibility test and PCR method to detect the antibiotic resistant gene. Our result found : These A. baumanni that resistant to most beta-lactam antibiotics, 87 % have ARI-1 (OXA 23) genes, and sensitive to most beta-lactam antibiotics , 86 % didn't have OXA 23 genes. We considered OXA 23 is important to beta-lactam resistant. Recent years in Taiwan , the antibiotic resistant problem of A. baumanni becomes very serious, hope using the resistant genes detect, can early to referral in clinical treatment in the future.