Acb complex為臨床上常見且具有多重抗藥性的伺機感染細菌，在臨床上難以被區分出正確的菌種。藉由次世代定序技術(NGS)，除了能準確的區分出臨床分離株的菌種，還能鑑定分離株中的多位點序列分型及其所攜帶的抗藥基因。為達到即時監控的目的，本研究將10株2016年來自台北榮民總醫院的臨床分離株進行分析，比較2台Illumina桌上型定序儀: iSeq100及MiSeq的效能。比較其原始產出數據和後續組裝統計的分析結果，iSeq100在各方面都比MiSeq來的穩定且可取得較完整基因體。在此，我們建立一個應用iSeq100定序儀監控臨床分離株的工作流程。
運用上述工作流程，分析自2019年7月至12月在臺北醫學大學附設醫院所分離的45抗碳青黴烯臨床鮑曼不動桿菌株。在多位點序列分型分析中，大多數分離株(17株)同時為ST208及ST1806序列型。而這些分離株中最常攜帶的β-內醯胺酶(β-lactamase)基因為blaADC-25、blaOXA-23和blaOXA-66，推測blaADC-25、blaOXA-23及blaOXA-66可能為當時Acb complex造成碳青黴烯抗藥性的主要因素之一。
將北醫附醫的臨床分離株分析結果與2015至2017年自台北榮總的493株分離株之基因體分析後資料進行比較。結果發現，在這兩批菌株中，最常出現的序列型為在一菌株中同時為ST208及ST1806。在這些臨床分離株中最常攜帶的β-內醯胺酶基因為blaADC-25、blaOXA-23和blaOXA-66。而在兩批菌株中，有超過半數的臨床分離株皆攜帶blaTEM-1D。推測此為當時造成菌株產生抗性的原因之一。此外，有超過半數的菌株同時帶有gdhB及其變異型，使同一菌株內同時出現兩種不同的序列型別。兩家醫院的時間及樣本數雖然有差異，但在β-內醯胺酶基因抗藥基因及多位點序列分型分析結果都具有相似的結果。且以iSeq100建立的新工作流程可以更好，更快速地分析其分離物中的抗藥基因和多位點序列分型。

The Acb complex is a clinically substantial opportunistic bacterium and notorious for its multidrug resistance. It is difficult to identity the correct species among the Acb complex in clinical specimens. Next-generation sequencing (NGS) technology can accurately determine bacterial species, multilocus sequence types (MLST), and antimicrobial resistance genes of clinical isolates. To achieve the goal of real-time monitoring, we chose 10 clinical isolates from the Taipei Veteran General Hospital (TVGH) in 2016 for comparing the performance of two benchtop sequencers, Illumina iSeq100, and MiSeq Systems. According to output data and assembly statistics, the iSeq100 system was more stable and suitable to obtain bacterial genomes than the Miseq system. Here, we established a new workflow for the application of clinical isolates by using the iSeq100 system. Forty-five clinical isolates of carbapenem-resistant A. baumannii for clinical monitoring were collected at Taipei Medical University Hospital (TMUH) from July 2019 to December 2019. The results showed that the 17 clinical isolates belonged to ST208 and ST1806 simultaneously and 66.5% of clinical isolates belonged to CC92. Analysis of β-lactamase genes showed that blaADC-25, blaOXA-23, and blaOXA-66 genes were detected in almost all isolates. We considered that it was one of the mechanisms rendering carbapenem resistance to the Acb complex. Comparing TMUH isolates with the other 493 isolates of TVGH collected from 2015 to 2017, the results in MLST and analysis of β-lactamase genes were similar. Besides, we found that the isolates had both gdhB (gdhB-3, gdhB-38, and gdhB-40) and its variations (gdhB-189, gdhB-182, and gdhB-212) leading to two sequences types in one isolate. Thus, the new workflow by iSeq100 system could effectively analyze resistance genes and MLST.

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