多重抗藥性鮑氏不動桿菌醫療照護相關感染危險因子分析

Abstract

鮑氏不動桿菌 (Acinetobactor baumannii，簡稱A. baumannii) 感染之問題在國內醫療機構相當常見，而其長時間存活及易對抗生素產生抗藥性之特性，容易產生多重抗藥性鮑氏不動桿菌 (multidrug-resistant A. baumannii；MDRAB)，根據Taiwan Nosocomial Infections Surveillance System (TNIS) 2011年資料顯示，醫學中心及區域醫院加護病房carbapenem-resistant A. baumannii (CRAB) 比例從2003年的小於20%，逐年上升至2011年第三季70%以上，由此可見其感染之問題在國內醫療機構相當常見。而醫療照護相關感染的發生牽涉到病人安全，將增加致病率、死亡率和醫療成本支出，故找出相關危險因子並制定介入措施相當重要。本研究在某區域教學醫院自2008年至2011年 (48個月) 期間，以回溯性病例對照研究方式(病例組：對照組=1：4配對)，分析MDRAB醫療照護相關感染之危險因子。研究結果顯示：在單變項分析中，住院天數、尿毒症、曾接受支氣管鏡檢查、雙腔導管、使用Glycopeptides類抗生素、使用Anti-Pseudomonal Cephalosporins類抗生素、使用第四代Cephalosporin類抗生素均為發生MDRAB醫療照護相關感染之顯著危險因子；以多變項conditional logistic regression調整干擾作用後，住院天數 (adjusted odds ratio:1.08 , P=0.002)、接受支氣管鏡檢查 (adjusted odds ratio:5.8, P=0.003)、使用Anti-Pseudomonal Cephalosporins類抗生素 (adjusted odds ratio:4.3, P=0.03)、使用第四代Cephalosporin類抗生素 (adjusted odds ratio:3.7 , P=0.03)此四項皆為醫療照護相關感染MDRAB之獨立危險因子。本研究結論為：適當選擇適合之抗生素用藥及管制後線抗生素使用，加強侵入性檢查後之環境清潔，為防治MDRAB醫療照護感染相當重要的一環。

Healthcare-associated infections (HAIs) of Acinetobactor baumannii is emeging as a serious issue in Taiwan. Multidrug-resistant A. baumannii (MDRAB) are often occurred due to its long surviving on environmental desiccation and antimicrobial resistance mechanisms. According to the data of Taiwan Nosocomial Infections Surveillance System (TNIS) in 2011, while the percentage of carbapenem-resistant A. baumannii (CRAB) in ICU of medical centers/ metropolitan hospitals was less than 20% in 2003, it rose to 70% in Q3 in 2010. It is essential to find relevant risk factors and make policies to prevent healthcare-associated infections because that will increase morbidity, mortality and medical costs. The purpose of this study is to investigate risk factors of MDRAB in a metropolitan hospital from 2008 to 2011 (48 months), using case-control study (case:control=1:4). Univariate analysis showed that days of hospitalization, uremia, bronchoscopy, double lumen, use of glycopeptides, use of Anti-Pseudomonal cephalosporins and use of the fourth generation cephalosporins, are statistically significant risk factors. Multiple conditional logistic regression analysis showed that, after adjusting for the effect of other variables, days of hospitalization, bronchoscopy, use of Anti-pseudomonal cephalosporins and use of the fourth generation cephalosporins remain independent risk factors. We concluded that, for MDRAB HAIs control, it is necessary to emphasize on proper antibiotics prescription, monitor antibiotics usages and environmental clean after invasive procedures.