台灣常見院內感染抗藥性細菌與預防

Common Antimicrobial-Resistant Bacteria in Nosocomial Infections in Taiwan and Their Prevention

抗藥性細菌的感染問題，尤其是多重抗藥性菌株，造成臨床治療上的困難，為全球關注之議題。在台灣，院內感染常見的抗藥性菌株有格蘭氏陽性的抗甲氧苯青黴素金黃色葡萄球菌及抗萬古黴素腸球菌以及格蘭氏陰性的碳青黴烯類抗藥之鮑氏不動桿菌、綠膿桿菌及克雷伯肺炎桿菌等。另外，有10－20%帶有超廣效性乙內醯胺酶的格蘭氏陰性菌對第三代cephalosporin有抗藥性，對fluoroquinolone具抗藥性的比例亦逐年遞增。抗藥性細菌對受感染者的生命安全造成重大威脅，致死率提高，但並非全然無法預防；為減緩抗藥性的問題，除了抗生素之適當及正確使用外，阻斷或減少抗藥性菌株的傳播，亦為直接的預防方法，手部衛生即是最簡單且最有效的預防院內感染之方法。因此，醫護人員對手部衛生的知識以及嚴格執行正確洗手的事項，是預防多重抗藥細菌的第一步，若能達成上述要求必能減少院內感染並提升醫療品質。

Infections caused by antibiotic-resistant bacteria, especially multidrug-resistant strains (MDR) that cause difficulties in clinical treatment, have long been a problem of global concern. Drug-resistant strains of common nosocomial infections in Taiwan include Gram-positive coccal methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, and Gram-negative bacilli such as carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae, among others. About 10 to 20% of Gram-negative bacteria that encode extended-spectrum β-lactamases are resistant to cephalosporin, a third generation antibiotic, and the fluoroquinolone-resistance rate has continued to increase in recent years. Despite the high mortality rate in patients with infections caused by MDR, the problem is still solvable by blocking or reducing MDR dissemination in addition to proper antibiotics use. Hand hygiene is the simplest, most effective measure for preventing nosocomial infections. However, healthcare workers’ adherence to recommended hand hygiene practices is unacceptably low worldwide, making the promotion of hand hygiene a major challenge for infection control experts. Therefore, as a first step of preventing the spread of MDR bacteria, knowledge of hand hygiene and adherence to hand hygiene practices must be required of healthcare workers. Such should help reduce nosocomial infections significantly and upgrade healthcare quality.