2017-08-012024-05-18https://scholars.lib.ntu.edu.tw/handle/123456789/706195摘要：實驗目標：1. 以甲型重組基因(RecA)作為洋蔥伯克氏菌複合群(Burkholderia cepaciacomplex)的鑑定黃金標準，評估基質輔助雷射脫附游離飛行時間質譜儀(matrix-assisted laser desorption ionization-time of flight)的鑑定率。2. 確認不同洋蔥伯克氏菌對於重症洋蔥伯克氏菌感染(包括菌血症、肺炎)之臨床意義。3. 找出重症洋蔥伯克氏菌感染之預後因子。背景：環境中富有洋蔥伯克氏菌複合群，尤其易成為先天性囊性纖維化(cysticfibrosis)患者之伺機性感染。過去認為僅先天性囊性纖維化患者為主要受感染者，近年來始成為重症單位常見之感染菌，然而卻鮮少文章討論於非先天性囊性纖維化患者(non-cyctic fibrosis)之感染。甲型重組基因已成為有效之洋蔥伯克氏菌複合群菌株鑑定方法，目前已知18 種菌株可分離自環境或人類。故本研究欲探討不同種(species)的洋蔥伯克氏菌複合群對於受感染之重症患者之臨床感染表現與預後差異不同，團隊初步資料顯示有此趨勢，而提高診斷速度有機會改善治療。實驗設計： 單一醫學中心回溯性世代研究實驗方法：蒐集臺大醫院2012 年3 月1 日至2016 年2 月29 日被診斷為洋蔥伯克氏菌複合群菌血症以及肺炎感染之重症患者臨床資料。分別以基質輔助雷射脫附游離飛行時間質譜儀、16S 核糖體RNA、甲型重組基因鑑定不重複病人之菌株。以瓊脂稀釋法確認菌株之抗生素敏感性。臨床影響：利用基質輔助雷射脫附游離飛行時間質譜儀，有效快速地正確鑑定出洋蔥伯克氏菌複合群之菌種，且正確評估洋蔥伯克氏菌複合群重症感染患者之預後。<br> Abstract: Study Aim:1. To determine the identification and classification power of matrix-assistedlaser desorption ionization-time of flight (MALDI-ToF) forBurkholderia cepacia complex (BCC) using RecA sequence as goldenstandard.2. To determine the impact of different BCC species and its clinicaloutcomes in critically ill patients with BCC bacteremia and/or pneumonia3. To determine the prognostic factors of critically ill patients with bacteremiaand/or pneumonia of different species of BCC.Background:Burkholderia cepacia complex (BCC) are enriched in our environmentand associated with opportunistic infection in humans, especially among cysticfibrosis (CF) patients. It is an emerging pathogen in patients acquiringhealthcare associated infections. However, of patients without cystic fibrosishad less been investigated.Recently, recA gene, a powerful taxonomic tools, is very useful for bothidentification and classification of BCC. All BCC species, at least 18 species todate, had been isolated from human specimen, though mostly from CFpatients. The impact of BCC bacteremia or pneumonia had been discussed insmall studies. However, scanty evidence exists between infection of differentBCC species and its clinical outcomes, no matter in critically ill patients.Different BCC species might cause different clinical outcome and ourpreliminary data supported this trend.Study design: A retrospective cohort study in a single medical centerMethod: Patients with BCC bacteraemia and/or pneumonia who were treatedat a medical centre from Mar 1st. 2012 to Feb 29th. 2016 were evaluated. BCCisolates were identified to species level by Bruker Biotyper MALDI-ToF MSand sequencing analysis by 16S rRNA and recA genes. Antimicrobialsusceptibilities of the isolates were determined by the agar dilution method.Clinical implication: Using MALDI-ToF to early identify critically ill patientswith BCC bacteremia and/or pneumonia to predict outcome precisely.洋蔥伯克氏菌甲型重組基因基質輔助雷射脫附游離飛行時間質譜儀Burkholderia cepacia complexrecA gene sequenceMALDI-ToF MS system