厭氧菌血症：令人煩惱的感染

Anaerobic Bacteremia: A Problematic Infection

厭氧菌可以造成許多內生性感染症而且也是血流感染的重要來源。相關研究指出厭氧菌造成感染整的主要族群為新生兒、小孩與成人及正在進行牙科治療的病人。厭氧菌血症最常培養分離到的菌株為Bacteroides group、Clostridium species、Fusobacterium species及Peptostreptococcus species。許多厭氧菌感染症多為伴隨需氧菌感染的多種菌株感染症而且在致病率與致死率上扮演重要角色。抗藥性厭氧菌的分離率從1970年便開始穩定增加。本文主要希望闡述目前數個主要的厭氧菌抗藥性問題。隨著clindamycin、ß-lactam、metronidazole及quinolone在厭氧菌抗藥情形的增加與Clostridium spp.對glycopeptides及lipopeptides的先天抗藥，這些藥物未來將可能不再是治療厭氧菌感染的首選藥物。最後總結，早期發現厭氧菌感染並給予適當治療是臨床治療的重要任務。監控厭氧菌的抗藥性的重要性與日趨增，這也說明了持續監控厭氧菌抗藥情形在院內感染管制的必需性。

Anaerobic bacteria cause a variety of endogenous infections and remain an important source of bloodstream infections. Studies of anaerobic bacteremia in newborns, children, adults, and inpatients under going dental procedures have shown that Bacteroides fragilis, Clostridium species, Fusobacterium species and Peptostreptococcus species are the most frequent blood culture isolates. Many of these anaerobic infections are co-infections with aerobic bacteria and play significant roles in morbidity and mortality. Antibiotic-resistant anaerobic infections have steadily increased since the early 1970s. This article aimed at highlighting the emerging antibiotic-resistance patterns in anaerobic bacteremia. With an increase in the prevalence of resistance to clindamycin, ß-lactam, metronidazole, and quinolone among anaerobic bacteria and intrinsic resistance to glycopeptides and lipopeptides in Clostridium species, these agents may not be the preferred therapy for anaerobic bacterial infections in the future. In conclusion, early recognition and appropriate treatment of these infections are important in clinical settings. Recognition of antibiotic resistance among anaerobes is increasingly critical for the control of nosocomial infection, emphasizing the need for continued monitoring.