病人鼻腔及肛門拭子培養應用於篩檢carbapenem-resistant Acinetobacter baumannii移生狀況的效果評估

Assessing the Utility of Anal and Nasal Swabs for the Screening of Carbapenem-Resistant Acinetobacter baumannii Colonization

Acinetobacter baumannii常造成醫院環境及醫療照護人員的雙手、衣物汙染，一不小心容易造成群聚感染，對於臨床上被發現帶有carbapenem-resistant A. baumannii（CRAB）之患者，一旦被隔離後，目前國內的實務做法會對此類患者進行主動篩檢追蹤，俟篩檢結果為陰性，方能解除隔離，但最適當的篩檢方式目前仍未有定論。回顧本院2010～2011年間，在12個有CRAB感染或移生的住院病人，以主動篩檢收集960個檢體，其中以鼻腔拭子的培養陽性率54.8%最高，其次為原部位檢體的34.6%，肛門拭子則只有17.1%，此三個不問檢體的陽性率比較具有統計學上顯著差異（P＜0.001）；再回顧上述所有病人的歷次篩檢結果則發現，如以節省篩檢成本、醫療級實驗室人力為考量，第一次篩檢建議包括原感染部位、肛門及鼻腔，但如果第一次肛門篩檢結果為陰性，後續即可不需再篩檢肛門拭子，只需篩檢鼻腔及原感染部位即可，直到這兩部位的篩檢結果連續2次都是陰性，病人才可以解除隔離。

Acinetobacter baumannii usually contaminates the hospital environment as well as the hands and clothes of healthcare workers. In addition, it can accidentally result in an outbreak of infection. The current clinical practice for patients with carbapenem-resistant A. baumannii (CRAB) is care in an isolation room with screening, which is continued until the screening results become negative. However, at present, no consensus has been reached regarding the most suitable screening method. In this study, we reviewed the records of 127 in-patients who underwent clinical specimen isolation for CRAB at the Chia-Yi Christian Hospital during 2010-2011. The assessment of the initial screening results revealed that the positive rate for nasal cavity swabs was significantly higher than that for anal swabs (61.4% and 20.5%, respectively, P < 0.0001). Therefore, to reduce screening costs and laboratory effort, it was suggested that the original infection site as well as anal and nasal cavities be tested only during the initial screening. If the results of the initial anal cavity screening were negative, it was not subsequently screened; only the nasal cavity and the original infected sites were tested further. Furthermore, isolation measures were discontinued when the results of 2 consecutive screenings of these 2 sites were negative.