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Share with You
我的研究歷程
臺北榮民總醫院內科部感染科主治醫師
國立陽明大學內科學科助理教授
林邑璁
2015-09-11
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Academic background
• Academic Training:
– M.D. (2004) National Yang-Ming University, Taipei,
Taiwan
– Ph.D. (2014) Institute of Clinical Medicine, National
Yang-Ming University, Taipei, Taiwan
• Hospital Appointment:
– 2004-2010: Resident doctor, Department of Medicine,
Taipei Veterans General Hospital
– 2010-2012: Attending Physician, Kingmen Hospital
– 2012-present: Attending Physician, Division of
Infectious Disease, Department of Medicine, Taipei
Veterans General Hospital
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Academic background
• Academic Appointments:
– 2014: Assistant Professor of Internal Medicine,
National Yang-Ming University, Taipei, Taiwan
• Board Certification:
– 2007: Board of Internal Medicine, Taiwan, R.O.C.
– 2009: Subspecialty of Infectious Diseases
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The topic of my research
• Infectious Diseases and Microbiology
– Chryseobacterium spp.
– Klebsiella pneumoniae liver abscess
– Klebsiella pneumoniae infection other than liver
abscess
– Antimicrobial resistance and virulence of Klebsiella
pneumoniae
– Others
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Research: In the beginning
(2007 fellowship in ID)
2014 IF=4.296, Rank 21/119, microbiology
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Research: In the beginning
2014 IF=1.495, Rank 61/78, infectious diseases
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• A limited number of reports have documented
bacteremia caused by Elizabethkingia
meningoseptica (Chryseobacterium
meningosepticum) in adults. Most cases have
occurred in Taiwan.
• We analyzed clinical features and outcomes of 32
patients (study period: 2004-2007) and
antimicrobial susceptibilities and pulsed-field gel
electrophoresis (PFGE) results of the isolates.
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Research: In the beginning
2014 IF=1.495, Rank 61/78, infectious diseases
16 patients during 2004-2008 with Chryseobacterium indologenes
were identified and the outcome was favorable.
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Summary
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同一主題連貫性的重要
相關的資料可以一起收集待未來研究
選擇別人少作的題材
選擇台灣特別的題材
臨床回溯性病例分析加上小部分的微生物
學知識
• Paper只要寫就有去處，即使低分的雜誌也
有其價值
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Research in Klebsiella pneumoniae
liver abscess
• Endemic disease in East Asia, especially
Taiwan
• The pathogenesis is not determined
– Bacterial translocation from intestine to liver in a
mice model
• The well-known risk factor is diabetes mellitus
• Metastatic infection complication from KPLA
• Virulence factors: capsule type K1/K2
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2014 IF=6.751, Rank 3/78, infectious diseases
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2014 IF=2.729, Rank 51/119, microbiology
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2014 IF=2.613, Rank 39/78, infectious diseases
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2014 IF=3.234, Rank 8/56, multidisciplinary sciences
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• The current study is the first to demonstrate the high economic burden
resulting from KPLA in a medical center in Taiwan.
• Standardizing the treatment protocol for KPLA inpatients and introducing an
outpatient parenteral antimicrobial therapy center to reduce the length of stay
may reduce costs, whereas development of a vaccine may be necessary to
tackle endemic KPLA in the future.
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2014 IF=5.003, Rank 18/153, medicine, general & internal
Age> 65, HBV
infection, HCV
infection
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2014 IF=5.997, Rank: 4/78, Infectious Diseases
 Use of amoxicillin/ampicillin may lead to overgrowth of K.
pneumoniae in the intestine and predispose to KPLA.
 We used an animal study and nationwide population-based
database to investigate the association between
ampicillin/amoxicillin use and KPLA in Taiwan.
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Our animal study suggests that oral ampicillin that disrupts the intestinal
microflora but lacks activity against serotype K1 K. pneumoniae may
promote KPLA in K. pneumoniae–colonized mice.
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 Exposure to ampicillin or amoxicillin within the previous 30
days predisposed to KPLA, and the dose–response
relationship was evident in the population-based study.
 We should avoid the overuse of these antibiotics in general
practice, and the refinement of antibiotic stewardship is
essential to prevent the undesired KPLA in the endemic
area.
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IF=5.727 Rank: 9/76, gastroenterology & hepatology
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2014 IF=3.731, Rank 23/78, infectious diseases
 TREM-1 (triggering receptor expressed onmyeloid cells 1)-mediated bacterial
clearance in the small intestine is an important immune response against K.
pneumoniae.
 TREM-1 deficiency enhances K. pneumoniae translocation in the small intestine and
increases mortality rates in mice with KPLA.
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Grant reviews
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Summary
• 詳盡的文獻回顧，找出臨床上沒有回答的
問題
• 同一主題連貫性的重要
• 選擇台灣特別的題材
• 臨床,健保資料庫,動物實驗及細菌的分子
生物學
• 主題皆是從臨床的觀察出發
• 初學從學習別人的文章架構開始
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Study of other
K. pneumoniae infection
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Research: respiratory infection
2014 IF=2.668, Rank 56/119, microbiology
2014 IF=2.613, Rank 39/78, infectious diseases
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• K. pneumoniae was the most frequent cause of
community-acquired thoracic empyema or
complicated parapneumonic effusion.
– It was associated with high mortality (32.4%) and was an
independent risk factor for fatal outcome.
• K. pneumoniae was the dominant cause of bacteremic
CAP and was associated with a more fulminant course
and a worse prognosis than bacteremic CAP due to
Streptococcus pneumoniae.
– Serotype K1 and K2 comprised around half of all isolates.
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2014 IF=3.989 Rank: 27/119, microbiology
 This study was conducted at the Taipei Veterans General Hospital during July,
2012 to February, 2014.
 The clinical characteristics in patients with community onset K.pneumoniae
pneumonia were analyzed.
 K.pneumoniae isolates from the nasopharynx of adults attending
otorhinolaryngology outpatient clinics were collected to compare the
microbiologcal features with those from pneumonia.
 Capsular genotypes, antimicrobial susceptibility, and multilocus sequence
type (MLST) were determined among these strains.
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Grant support
• Community-onset pneumonia due to
Klebsiella pneumoniae: clinical and
microbiological characteristics, treatment, and
pathogenesis of the disease
• Ministry of Science and Technology, Taiwan,
R.O.C.
• 201408-201607: Total direct support:
2,000,000 NTD
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2014 IF=1.495, Rank 61/78, infectious diseases
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2014 IF=4.441, Rank 13/78, infectious diseases
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2014 IF=2.349, Rank 69/119, microbiology
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2014 IF=2.613, Rank 39/78, infectious diseases
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Summary
• 同一主題連貫性的重要—申請計畫
• 建立臨床菌株的資料庫
• 可用各種不同的variable (細菌抗藥性、
宿主因素等)來探討不同的主題
• 臨床的資料配合微生物學的實驗
• 主題皆是從臨床的觀察出發
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多中心的臨床研究
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2014 IF=2.349, Rank 69/119, microbiology
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2014 IF=5.723 Rank: 15/153, medicine, general & internal
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By Best Colleagues !!
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Summary
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帶著醫學生一起建立龐大的資料庫
帶著學生分析其整理的臨床數據以及統計
資料的正確性很高
多中心的研究不容易進行
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Summary of my research
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主管及團隊的支持
努力的臨床工作帶來許多的靈感
努力帶醫學生:教學相長
臨床研究不間斷進行
基礎研究需要時間及耐心耕耘，實驗失敗
或沒有結果是常見的事!!
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Acknowledgement
• 感謝北榮陳適安主任，馮長風主任
• 感謝陽明楊翠青教授
• 感謝三總感染科團隊
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Thanks For Your Attention
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