整形外科病房Pandrug-Resistant Acinetobacter baumannii感染調查

Epidemiological Study of Pan-drug Resistant Acinetobacter baumannii in a Plastic Surgery Ward

此調查報告乃針對整形外科病房連續四天內出現五位Acinetobacter baumannii陽性個案，經細菌學檢查發現四株Acinetobacter baumannii的抗生素敏感試驗結果相同，對所有抗生素皆產生抗藥性，經專家判定為Pandrug-Resistant Acinetobacter baumannii（PDRAB），為免個案繼續增加，故進行環境、人員調查及資料收集整理。此五位個案並非因傷口情況惡化執行細菌培養，皆是醫師定期常規由傷口執行細菌培養而得知細菌報告。結果分析五位個案住院天數皆超過二星期、長期臥床、細菌培養前10-14天皆曾使用過廣效性抗生素及第三代頭芽孢子素（cephalosporins）。另，本次調查發現，在環境及工作人員手部採檢細菌報告中，並無檢測出與病患相同的菌種，故初步判定為移生菌，並非工作人員導致之交互感染。此次事件雖為病人本身潛在危險因子導致，但由於及時的執行相關感染管制措施及抗生素管制，而未釀成群突發的結果。故加強員工各項感染管制及新知的在職教育，是醫療人員未來需要努力的目標。

This study aimed to investigate five cases of positive Acinetobacter baumannii infection in a plastic surgery ward, over a four day period. After examination by bacterial culture, results for minimal inhibitory concentration (MIC) of Acinetobacter baumannii and tests of anti-Acinetobacter baumannii medication were the same. An expert confirmed the source of infection was pan-drug resistant Acinetobacter baumannii. To prevent further cases, data from the environment was collected and an investigation of hospital staff was undertaken. Wound samples were regularly taken by a physician from the five infected patients. Analysis of the results showed that hospital stay was more than two weeks and the patients were on bed-rest for long periods. Also, 10 to 14 days prior to the wound samples being taken, the patients were receiving third generation cephalosporin. Moreover, we found that cultures grown from samples taken from the hands of hospital staff and the environment were different from the bacteria grown from the wound samples taken from the patients. Therefore, we are sure these infections did not arise from cross contamination from hospital staff to patients. In this case, risk factors must have been present in the patients themselves, since there was direct management of controlling sources of infection by limiting the use of antibiotics, and there was no other group of infection found. Education regarding the control of sources of infection and greater knowledge for hospital staff is required in the future.