曾博修羅雪霞陳盈文Ying-Wen Chen生化微生物免疫研究所2026-10-299999-12-312016https://handle.ncl.edu.tw/11296/yscnmnhttps://scholars.csmu.edu.tw/handle/123456789/36201凝固酶陰性葡萄球菌 ( Coagulase-negative staphylococci, CoNS ) 為人體正常菌叢，但CoNS也會引起心內膜炎、導管相關性菌血症、人工關節感染及泌尿道等伺機性感染。因為CoNS引起的感染逐年增高且常有抗藥問題，導致治療上的困難，近年來日益受到重視。Vancomycin和teicoplanin是臨床治療多重抗藥CoNS感染的經驗性常用藥物，但目前尚少人針對中臺灣地區CoNS分離株進行vancomycin和teicoplanin抗藥性的研究。本研究利用2007年5月起自行政院衛生福利部中區微生物中央實驗室收集的200株CoNS臨床分離株進行分析，以美國臨床實驗室標準委員會（Clinical and Laboratory Standards Institute) 建議的微量肉湯稀釋試驗 ( broth microdilution, BMD ) 為測定CoNS菌株對vancomycin和teicoplanin的最低抑菌濃度 ( minimum inhibitory concentration, MIC ) 之標準法，並與商用Vitek 2自動分析儀之分析結果進行比較。結果顯示，BMD和Vitek 2法測定vancomycin的藥敏結果均為100% 感受性；在teicoplanin 部分，BMD結果為100% 感受性，但Vitek 2則為91% 感受性、7% 中間型和2% 抗性。二種方法分析對vancomycin和teicoplanin 的essential agreement ( EA ) 分別達93% 和54%，顯示醫院常規使用的Vitek 2自動分析儀對於偵測vancomycin的準確度和CLSI所建議的BMD法相當一致，但Vitek 2對CoNS的teicoplanin藥敏測定上較可能有誤差。針對18株經Vitek 2分析對teicoplanin 為intermediate 或resistant，而BMD為susceptible 的分離株重複操作藥敏試驗，結果顯示BMD法二次結果一致，但Vitek 2的結果，11株原為intermediate及3株原為resistant，均改為susceptible，只有4株兩次結果皆為intermediate。本研究顯示，中臺灣地區CoNS對vancomycin 和teicoplanin仍呈現高度感受性，而Vitek 2測定CoNS對teicoplanin感受性若為intermediate 或resistant，建議可使用BMD法以確認其MIC。為預防和控制抗藥性CoNS菌株的產生與流行，未來仍須持續監控中臺灣CoNS對vancomycin和teicoplanin 的感受性。Coagulase-negative staphylococci (CoNS) are frequent human normal flora. However, CoNS also caused opportunistic infections, leading to endocarditis, catheter-related bacteremia, artificial joint infections, and urinary tract infections. CoNS infections have increased and drug resistance of CoNS might lead to therapy failure. Therefore, CoNS are getting more and more attention. Both vancomycin and teicoplanin are commonly empirical antibiotics for the treatment of infections caused by multidrug-resistant CoNS. However, studies concerning vancomycin and teicoplanin susceptibilities of CoNS isolates in central Taiwan were limited. The present study performed vancomycin and teicoplanin susceptibility test of 200 CoNS clinical isolates from the Central Laboratory of Central Region Hospital Alliance. Broth microdilution ( BMD ) according to Clinical and Laboratory Standards Institute was used as the standard to detect vancomycin and teicoplanin minimum inhibitory concentration ( MIC ). The commercial Vitek 2 system was also performed and compared with BMD. The results showed that all 200 CoNS isolates were susceptible to vancomycin using both methods. For teicoplanin, BMD method revealed 100% susceptibility, however, Vitek 2 revealed 91% susceptibility, 7% intermediate and 2% resistance. The essential agreement ( EA ) of these two methods toward vancomycin and teicoplanin were 93% and 54%, respectively. The Vitek 2 and BMD methods were quite consistent for the detection of vancomycin MIC. But, Vitek 2 method showed some different from BMD for the detection of teicoplanin MIC. Both methods were repeatedly performed for 18 isolates with discrepancy teicoplanin MIC. The BMD showed quite consistent results, while 11 intermediate and 3 resistant isolates turned to be susceptible using Vitek 2 method. According to this study, CoNS isolates still are highly susceptible to vancomycin and teicoplanin in central Taiwan. The BMD method is recommended for isolate showing teicoplanin intermediate or resistant phenotype by Vitek 2 method. To provide precise result for clinical treatment and prevent the spread of multidrug-resistant strains, continuous monitor of vancomycin and teicoplanin susceptibilities of CoNS in this area is required in the future.凝固&#37238陰性葡萄球菌萬古黴素壁黴素抗生素感受性試驗Coagulase-negative staphylococciVancomycinTeicoplaninAntimicrobial susceptibility testthesis