CRE診斷、治療與醫院感染管制 解答

關於多重抗藥性菌種院內感染之影響 ，下列何者正確?

• 1.延長住院日數，造成殘疾、失去生命
• 2.關閉病房、院譽受損、負法律責任
• 3.增加工作量，增加感染之危險性
• 4.以上皆是

關於CRE(carbapenem-Resistant enterobacteriaceae)的Identification，下列何者有誤?

• 1.Clinical Laboratory and Standards Institute (CLSI) 為了偵測carbapenemase 的存在,已將MIC Breakpoints for Carbapenems提高
• 2.Identification of E. coli or K. pneumoniae with overt resistance to any of the carbapenems should raise suspicion that it may be harboring a carbapenemase enzyme.
• 3.臺灣的CDC有做CRE的抗藥性檢測
• 4.NDM-1腸道菌感染症是法定傳染病

Infection Control for CRE (carbapenem-resistant enterobacteriaceae) ，下列何者有誤?

• 1.Hospitalized patients infected or colonized with carbapenemase-producing bacteria should be placed on airborn precautions
• 2.Hand hygiene
• 3.Antimicrobial stewardship
• 4.Screening high-risk patients to detect rectal colonization.

關於 Antimicrobial Therapy for CRE (carbapenem-resistant enterobacteriaceae)

• 1.The optimal treatment of infection due to carbapenemase-producing organisms is uncertain
• 2.CRE 會 confers resistance to all penicillins, cephalosporins, and carbapenems
• 3.For severe infections, monotherapy 較combination antimicrobial therapy with two or more agents 效果 為佳
• 4.Emergence of resistance during monotherapy

CRE(carbapenem-Resistantenterobacteriaceae)的transmission，下列何者有誤?

• 1.Enterobacteriaceae，which harbor carbopenem-encoding genes，can spread from person to person
• 2.Cross-infection within &outside of health system
• 3.Health workers 的手也是主要傳播媒介
• 4.CRE因帶有mobile genetic elements，不會wide spread transmission to other isolates & genera of bacteria

關于NDM(New Delhi metallo-β-lactamase)何者不正確?

• 1.Genetic element為chromosome
• 2.Medical tourism 造成全球的擴散
• 3.Widespread nonprescription use of antibiotics in India造成huge selection pressure
• 4.Most common in E coli

細菌對carbapenem有抗藥性的機制，下列何者不是？

• 1.Loss of porins
• 2.β-lactamase
• 3.Overexpression of efflux pump
• 4.Target mutations

下列何者carbapenemase在USA最常見

• 1.KPC (Klebsiella pneumoniae carbapenemase)
• 2.NDM (New Delhi metallo-β-lactamase)
• 3.Oxacillinase
• 4.Amp C-like

關於CRE(carbapenem-resistant enterobacteriaceae)的臨床表現，下列何者有誤?

• 1.Asymptomatic colonization
• 2.Outbreaks due to hospital-based clonal spread
• 3.Central venous catheter infections.
• 4.以上皆非

下列何種情況 應考慮對病人應進行CRE (carbapenem-resistant enterobacteriaceae)主動篩檢?

• 1.經調查後確定院內高風險區域
• 2.於48小時內來自高風險區域（如：長照機構或已證實有CRE院內群突發醫院）之入院病人。
• 3.病人須移轉至院內高風險區域（如：ICU）時。
• 4.以上皆是

關於預防多重抗藥性菌種在病房傳播，下列何者有誤?

• 1.病人在單位間互轉，不用先告知是否為多重抗藥性菌種
• 2.優先考慮將多重抗藥性菌種病人安置在單人病房
• 3.將帶有相同多重抗藥性微生物的病人，集中照護
• 4.不建議將帶有多重抗藥性菌種病人安置於高傳染風險病人旁

關於多重抗藥性菌種發生的經過 ，下列何者正確?

• 1.在自然界中,原本就有抗藥性菌種存在
• 2.使用抗生素 ,除了殺死病菌, 也會破壞體內正常的菌種, 而使抗藥性菌種有機會增長.
• 3.抗藥性菌種會將抗藥性基因傳播給其他非抗藥性菌種
• 4.以上皆是

關於多重抗藥性菌種的院內感染管制措施 ，下列何者不正確?

• 1.Hand hygiene
• 2.Standard and contact precautions (e.g., gowns, gloves)
• 3.Cohorting of patients and staff,
• 4.以上皆不正確

關于KPC(Klebsiella pneumoniae carbapenemase)，何者有誤?

• 1.Higher incidence in long-term care facilities than in acute care hospitals in U.S.A
• 2.會造成hospital outbreak
• 3.Transmissible plasmids
• 4.Can not transmitted from klebsiella to other genera

Factors of antibiotic resistance，包括

• 1.Aging population
• 2.Chronic disease
• 3.Invasive medical treatment
• 4.以上皆是