鮑氏不動桿菌

Acinetobacter baumannii

鮑氏不動桿菌普遍存在於無生命的自然界環境中，因其可長時間存活、易造成醫院環境污染以及容易產生抗藥性的特性，故常引起院內醫療照護相關感染事件，並併發為群聚感染，如菌血症、肺炎、泌尿道感染…等，且感染後的病人死亡率可高達46-63.9％。鮑氏不動桿菌的群聚感染事件，採取之介入措施，首重各類人員的在職教育、要求落實執行洗手五時機，將Acinetobacter baumannii 感染及移生的個案集中照護，進行成組護理（cohort care），同時加強環境清潔與消毒。近幾年來，加護病房對碳氫黴烯類抗生素具抗藥性的鮑氏不動桿菌（carbapenem-resistant A.baumannii；CRAB） 造成醫療照護相關感染的比率從2003 年18 ％上升到2010 年第二季的64 ％，因為臨床上過度使用後線廣效抗生素而導致多重抗藥性鮑氏不動桿菌（multiple drug-resistant A. baumannii; MDRAB）上升之問題，已嚴重影響到病人治療上面臨無抗生素可用的窘境，也是全球即刻需面對的重要課題。故嚴格的抗生素開立管制將是預防A. baumannii 抗藥性產生的最重要因素。

Acinetobacter baumannii was found extensively in the natural environment. It can survive environmental desiccation for weeks, a characteristic that facilitates transmission through fomites in hospitals. Recently, it has emerged as an important nosocomial pathogen and been implicated in hospital outbreaks, especially in ICUs. Clinical infections caused by A. baumannii included bloodstream infections, pneumonia, skin and soft-tissue infections, and urinary tract infections etc. Severe infection could lead to a mortality rate as high as 46-63.9 %. The effective intervention methods against an A. baumannii outbreak should include increased staff education, persistent promotion of hand hygiene, cohorting, isolation, and vigorous environmental cleansing. In recent years, the emergence of carbapenem-resistant or even pandrug-resistant A. baumannii has been an increasing problem for both controlling and treating nosocomial infections. In Taiwan, the prevalence rate of carbapenem-resistant A. baumannii in ICUs had been rising from 18% in 2003 to 64% in 2010. Antimicrobial resistance greatly limits the therapeutic options for patients who are infected with this organism. Strict antibiotic control is the most important measure of preventing drug resistance and reducing the impact of emerging A. baumannii infection.