2011-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/657247摘要：鮑氏不動桿菌(Acinetobacter baumannii)近年來在全世界成為重要的院內致病菌之一。其生長條件只需少許營養即可存活，故可在乾燥的環境中存活長達1-5個月之久，導致容易在院內傳播並造成感染。目前歐洲､北美､亞洲､中東､澳洲等地都有發生規模不小的不動桿菌群突發。常見不動桿菌感染的臨床表現為肺炎、菌血症、軟組織感染及腦膜炎等。菌血症死亡率在非加護病房病患為16.3%､而在加護病房病患死亡率可高達34.0-43.4%。和其他格蘭氏陰性菌菌血症相較，不動桿菌血症的死亡率較高(57% vs.31-43%, p<0.05)。面對抗生素的壓力，此細菌對各式抗生素快速發展出多重抗藥性，故一旦感染，相當難以治療。國內的研究顯示，有carbapenem抗藥性不動桿菌菌血症的死亡率遠高於無carbapenem抗藥性不動桿菌菌血症的死亡率(46.0% vs. 28.3%, p<0.05)。根據臺大醫院的資料，對傳統5或6種抗生素有抗藥性的不動桿菌菌血症佔所有不動桿菌菌血症的比例，在西元2007, 2008, 2009年，分別為24.9% (54/217), 33.7% (68/202),32.2% (86/267)。雖然多種抗生素合併治療不動桿菌感染在體外及動物實驗有協同作用及增加存活的結果，但在目前多重抗藥性不動桿菌不斷增加的狀況下，不同抗生素治療療效比較的臨床研究仍稀少，而且受到許多病人的干擾因素所影響。是否多種抗生素合併使用對高抗藥性不動桿菌菌血症有效，何種合併處方較佳，目前仍未知。過去研究證實即時聚合酶鏈鎖反應能偵測病人血中菌量且不受病人的其它干擾因素影響，能直接影響病人的預後。故本研究欲追蹤罹患鮑氏不動桿菌菌血症且接受抗生素治療的病患，利用即時聚合酶鏈鎖反應以比較不同抗生素的治療效果及探討和死亡相關之危險因子，以期找到最佳的治療處方以改善病人的預後。<br> Abstract: Acinetobacter baumannii (A. baumannii) have emerged as an important pathogen inhospital settings worldwide. With the ability to survive on dry inanimate surfaces for 1-5months and mechanisms to facilitate colonization of patients or medical equipment, A.baumannii propagate easily and cause significant infections in susceptible hosts. Numerousoutbreaks of A. baumannii have been documented in Europe, North America, Asia, MiddleEast, and Australia. Moreover, the clinical problem with Acinetobacter species is not only ofmagnitude but also of severity. Mortality of bacteremia caused by Acinetobacter species issignificantly higher than that by other Gram-negative bacteria (57% vs. 31-43%, p<0.05).Furthermore, mortality of bacteremia caused by carbapenem-resistant Acinetobacter species issignificantly higher than that by carbapenem-susceptible Acinetobacter species (46.0% vs.28.3%, p<0.05).Acinetobacter species employ several resistance mechanisms enabling survival underselective antimicrobial pressure, and specific treatment is further complicated by multidrugresistance. At our hospital, the percentage of bacteremia caused by highly resistantAcinetobacter species, defined as isolates resistant to 5 or 6 antimicrobial classes in allbacteremia caused by Acinetobacter species is 24.9% (54/217), 33.7% (68/202) and 32.2%(86/267) in 2007, 2008 and 2009, respectively. Under the circumstance of increasingmultidrug resistance A. baumannii, despite encouraging results from in vitro and animalstudies, there are only few clinical studies compared the outcomes of different antimicrobialregimens, and the most studies are confounded by multiple co-morbidities of the bacteremicpatients. Which antimicrobial regimen is better and would improve clinical outcome remainsunknown in patients with bacteremia caused by these highly resistant Acinetobacterbaumannii. Realtime PCR had been documented to quantify bacterial load of bacteremia,which can predict clinical outcome independent to other confounding factors of patients.Thus, the present study will enroll patients with bacteremia caused by Acinetobacterbaumannii and treated with antimicrobial therapy to assess treatment outcomes using realtimePCR quantification and to analyze risk factors associated with mortality, in order to find outthe best treatment regimen to improve outcomes of the patients.Key words: Acinetobacter baumannii, bacteremia, realtime polymerase無Acinetobacter baumanniibacteremiaOxa-51 genebacterial load