2011-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/645319摘要：萬古黴素抗藥性腸球菌(VRE)自1990年代起, 已造成美國醫院的嚴重衝擊. 在過去的研究中發現, 造成院內群突發的VRE, 比起不曾引起院內群突發的VRE, 通常具有特殊的毒力因子(virulent factors)或殺菌素(bacteriocins). 而VRE之所以受到重視, 不僅是因為它的抗藥性造成了治療上的選擇有限; 更因為它可以將這樣的抗藥性傳遞給其它的格蘭氏陽性菌, 如青黴素抗藥性金黃色葡萄球菌(MRSA), 使對方也轉變為對萬古黴素具抗藥性.VRE過去在臺灣, 問題一向不是很嚴重. 根據本院的監測資料顯示, 在過去的十年中, 引起院內感染的腸球菌約只有4%到6%是VRE. 然而, 自2007年12月起, 本院的監測即發現VRE的發現比率越來越高; 在2008年中, 甚至高到14.5%. 在這當中, 本院的感控措施並無改變, 萬古黴素的使用量並沒有增加, 而多重抗藥性鮑氏不動桿菌(Acinetobacter baumannii)及MRSA的盛行率反有下降的趨勢. 而自TNIS全台的監測資料也顯示, 許多醫院的VRE有迅速增加的趨勢. 因此, 是否有一新被引入的VRE clone, 由於帶著特殊的基因而表現出生態上的優越性, 是十分重要並需要儘快釐清的.本研究計劃將利用PCR的方法, 對本院所分離出的VRE進行抗藥性基因分型, 分子分型, 毒力因子與殺菌素之檢測; 以釐清上述之疑問.<br> Abstract: Vancomycin-resistant enterococci (VRE) have become a great loading and impact on American hospitals since 1990s. Based on the findings of prior studies, it was found that the epidemic VRE isolates had the tendency to carry special virulent genes and genes encoding bacteriocins compared to the non-epidemic VRE. Nosocomial infections caused by VRE usually led to challenges to clinicians for the limited choice of therapeutic drugs and significantly additional mortality as well as morbidity. In addition, the transferability of the genes encoding vancomycin resistance in VRE leads to another concern that VRE can transfer these genes into other Gram-positive bacteria and transform them into vancomycin-resistant organisms.In Taiwan, the burden of VRE was used to be not as heavy as that of USA. According to the surveillance data from our hospital, the proportion of VRE among all enterococci causing nosocomial infections ranged from 4% to 6% during the past decade. However, this proportion was noted to increase rapidly since December 2007 (up to 8.2%) and remained high during 2008 (9.9% to 14.5%). During this meanwhile, the infection control interventions at our hospital were not changed and the prevalence of other drug-resistant bacteria, such as multidrug-resistant Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus, had decreased. Data from the Taiwan Nosocomial Infection Surveillance System (TNIS) also discovered that VRE had caused several outbreaks at various hospitals and increased rapidly at the same time. Therefore, it is important to clarify whether there is a new VRE clone, which carries special virulent factors and secrets some bacteriocins and thus lead to its ecological advantage over other nosocomial bacteria, introduced into our hospital (Taiwan).In the following study, VRE isolates from our hospital surveillance will be examined for their genotypes of vancomycin resistance, molecular epidemiology, genes encoding virulent factors as well as bacteriocins using polymerase chain reaction methods.