臺灣南部某醫學中心KPC-2與KPC-17產碳青黴烯酶腸桿菌菌株特性之比較

Comparison of Characteristics of KPC-2 and KPC-17 Carbapenemase-Producing Enterobacteriaceae Strains in A Southern Taiwanese Medical Center

本研究回溯2020年至2022年臺灣南部某醫學中心726株carbapenem-resistant Enterobacteriaceae (CRE)菌株，分析其基因定序，並針對其中共136株帶有KPC基因的菌株進行分組分析，包括102株KPC-2及34株KPC-17。檢出KPC的菌株中，以Klebsiella pneumoniae最多佔83.8%；其次為Escherichia coli 9.6%。檢體來源以尿液和痰液為主，分別為36.8%及30.2%。比較KPC-2與KPC-17兩種不同基因型菌株之特性，雖然兩組之間在個案之人口學、菌株種類、就醫來源、住院天數、抗生素使用史、及死亡率，沒有達到統計顯著差異，但發現有三種抗生素之抗藥性在兩組之間有統計顯著差異（皆為p < 0.05），包括amikacin、gentamicin、以及tigecycline。兩組病人之就醫來源雖然均以住家佔多數，但是一年內反覆住院的比率也高。此外，對於過去一年曾經住院的族群中，我們也發現曾在3個月或6個月內住院的病人，較容易感染KPC-17。國內各醫療院所在抗生素廣泛使用下，使得碳青黴烯酶抗藥性基因的傳播不只會在醫療院所中發生，同時也會在社區中有傳播的可能。因此我們應該加強抗生素的管理及落實感染管制措施，以降低抗藥性菌種的散佈。

This study retrospectively analyzed the genetic sequences of 726 carbapenemresistant Enterobacteriaceae (CRE) strains isolated from a southern Taiwanese medical center from January 01, 2020 to December 31, 2022. A total of 136 Klebsiella pneumoniae carbapenemase (KPC)-producing strains (102 KPC-2 and 34 KPC-17) were identified and grouped for analysis. Among the KPC-carrying pathogens, 83.8% were K. pneumoniae and 9.6% were Escherichia coli. The most common specimen types were urine and sputum, accounting for 36.8% and 30.2% of the samples, respectively. Although this study did not find statistically significant differences between the two groups in terms of demography, bacterial species, origin, average length of hospitalization, previous antibiotic use, and mortality rate, significant differences were observed in the resistance rates to three antibiotics (all with p values < 0.05): amikacin, gentamicin, and tigecycline. Although the patients in both groups mainly came from home, the previous hospitalization rates within 1 year were also high. Additionally, the patients who were hospitalized within the previous 3–6 months were more likely to acquire infection with KPC-17-producing strains. Owing to the widespread use of antibiotics in medical institutions in Taiwan, the spread of carbapenemase-encoding genes occurs in hospitals, communities, and long-term care facilities. Therefore, it is crucial to strengthen antibiotic stewardship and infection control measures to reduce the emergence and further transmission of carbapenem-resistant strains.