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dc.contributor.authorLiu, Meei-Fangen_US
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dc.description.abstract摘 要 金黃色葡萄球菌(Staphylococcus aureus)是醫院最常見的致病菌,自從1961年分離出第一株抗甲氧苯青黴素金黃色葡萄球菌(methecillin resistant Staphylococcus aureus;MRSA)之後,MRSA很快的出現在各國,由於抗生素的大量使用,使MRSA成為目前院內感染最常見的菌種。本研究收集台灣地區5家醫院自2001年1月至2008年3月共107株MRSA,期望藉脈衝電場電泳基因分型法(Pulsed-field gel electrophoresis;PFGE)、多基因組序列分析(Multilocuse sequence typing;MLST)兩種方法,分析菌株的基因相關性,並進一步和其他國家比較,找出台灣的本土流行株,並比較台灣不同地域MRSA的親源相關性。脈衝電場電泳結果,經比對分析菌株親緣樹枝圖後,親緣百分比>80%即定義為同一族群(cluster),因此得到五種族群:A(80.5%)、B(89.8%)、C(80.4%)、D(88.0%)與E(87.5%),其中A群與B群全台5家醫院都存在此兩群,C、D、E群則各分布在不同醫院。本次107株MRSA經MLST分型再與資料庫比對,共87株可比對,且有6種型別,包括:ST239、ST59、ST241、ST5、ST25與ST221,最主要的是ST239與ST59,各佔59.8%與13%。從本研究發現ST239是臺灣最主要的流行株,與亞洲國家有些異同,如韓國主要的流行株是ST5與ST239,而日本主要的流行株是ST5,又中國的主要菌株是ST239,和台灣具相同的流行株,原因可能是中國和台灣經常有台商和探親來往頻繁之故。另一方面,本研究呈現MRSA在臺灣的醫院是廣泛分佈的,所以醫院對於此抗藥性菌株,除了持續的監測,完備的感控措施及完善的抗生素管制外,嚴謹的院內感染管制政策的落實,是最重要的預防院內感染(nosocomial infection)之道。zh_TW
dc.description.tableofcontents目 次 誌謝--------------------------------------------------------------- i 中文摘要----------------------------------------------------------- ii 英文摘要-------------------------------------------------------- iii 目次------------------------------------------------------------------------- iv 圖表次----------------------------------------------------------------------- v 壹、前言-------------------------------------------------------------------- 1 貳、材 料 與 方 法 一、菌株來源-------------------------------------------------------------- 6 二、藥品-------------------------------------------------------------------- 7 三、培養基----------------------------------------------------------------- 7 四、抗生素----------------------------------------------------------------- 8 五、細菌之培養與鑑定-------------------------------------------------- 8 六、最低抑菌濃度-------------------------------------------------------- 11 七、脈衝電場電泳法----------------------------------------------------- 12 八、PFGE條紋片段的比對---------------------------------------------- 14 九、DNA萃取--------------------------------------------------------------- 15 十、進行MLST前的PCR反應------------------------------------------- 15 十一、多基因定序分型-------------------------------------------------- 16 十二、mecA測定---------------------------------------------------------- 17 叁、結果 一、細菌鑑定-------------------------------------------------------------- 18 二、最低抑菌濃度-------------------------------------------------------- 18 三、PCR反應--------------------------------------------------------------- 19 四、脈衝電場電泳-------------------------------------------------------- 19 五、多基因定序分型----------------------------------------------------- 20 肆、討論-------------------------------------------------------------------- 21 伍、結論-------------------------------------------------------------------- 27 陸、參考文獻-------------------------------------------------------------- 48 柒、附錄-------------------------------------------------------------------------------- 63 圖 表 次 表一金黃色葡萄球菌對oxacillin的最低抑菌濃度結果-------- 30 表二、MLST PCR引子的序列------------------------------------------ 31 表三、MLST基因型的表現--------------------------------------- 32 表四、台灣地區醫院ST的分布--------------------------------------- 33 表五、臺灣地區PFGE型別的分佈------------------------------------ 34 圖一、金黃色葡萄球菌在血液培養基的菌落型態----------------- 35 圖二、革蘭氏染色結果-------------------------------------------------- 36 圖三、tpi、gmk與pta為引子的PCR產物--------------------------- 37 圖四、mecA為引子的PCR產物--------------------------------------- 38 圖五、MRSA的脈衝電場電泳結果------------------------------------- 39 圖六、107株MRSA的PFGE結果親緣樹枝圖------------------------ 40 圖七、中榮MRSA的PFGE結果親緣樹枝圖------------------------ 41 圖八、馬偕MRSA的PFGE結果親緣樹枝圖-------------------------- 42 圖九、桃園MRSA的PFGE結果親緣樹枝--------------------------- 43 圖十、屏東MRSA的PFGE結果親緣樹枝圖------------------------ 44 圖十一、高雄MRSA的PFGE結果親緣樹枝圖-------------------- 45 圖十二、ST59的PFGE結果親緣樹枝圖------------------------------ 46 圖十三、ST239的PFGE結果親緣樹枝圖---------------------------- 47zh_TW
dc.subjectnosocomial infectionen_US
dc.titleEpidemiology of methecillin resistant Staphylococcus aureus isolates in Taiwanen_US
dc.typeThesis and Dissertationzh_TW
item.fulltextno fulltext-
item.openairetypeThesis and Dissertation-
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