內科加護病房導尿管相關泌尿道感染之危險因子調查

Risk Factors for Catheter-associated Urinary Tract Infections in Medical Intensive Care Units: A Case-Control Study

加護病房的病人由於疾病嚴重度較高，因此臨床上常需要接受侵入性導管及相關治療處置，以確切掌握病人的生理徵象狀況，但正因為如此也增加了醫療照護相關感染的風險。在台灣院內感染監視資訊系統的最新資料顯示，醫療照護相關泌尿道感染（healthcare-associated urinary tract infections, healthcare-associated UTI）為區域醫院加護病房感染部位之第1位，而醫學中心則為第2位（僅次於血流感染）。本研究目的採用病例對照研究方法來探討加護病房導尿管相關泌尿道感染（catheter-associated urinary tract infections, CAUTI）之風險因子。在2013至2017年研究的期間，我們的內科加護病房總共發現了39例CAUTI的患者，並配對73例對照個案加以分析，研究結果單變項分析顯示，導尿管留置天數、糖尿病病人、使用類固醇的病人及導尿管置放地點在加護病房得到CAUTI風險明顯較高；而進一步多變項分析後，有三個獨立因子具有統計意義，分別是導尿管留置天數（OR＝1.23；p＝0.002）、置放導尿管地點在加護病房（OR＝6.12；p＝0.007）及糖尿病病人（OR＝5.87；p＝0.027）罹患CAUTI的風險具有統計意義。本研究結果能提供後續醫療人員未來在加護病房病人照護有關感染管制上的參考建議，並希望進而減少醫療照護相關泌尿道感染的發生。

Owing to severe illnesses warranting intensive care unit (ICU) admission and the use of several invasive medical devices in this setting, patients admitted to intensive care units (ICUs) are at a high risk of health care-associated infections. Based on the latest data available from the Taiwan Nosocomial Infection Surveillance system, healthcare-associated urinary tract infections (UTIs) are the most common nosocomial infections identified in the ICU of regional hospitals, second only to bloodstream infections identified in medical centers. This case-control study investigated the risk factors for catheter-associated UTI (CAUTI) in ICUs. During a 5-year study period, we identified 39 patients with CAUTI admitted to our medical ICU. These 39 patients were categorized as cases and were matched with 73 patients who were categorized as controls for the matched analysis. Univariate analysis showed that prolonged catheterization, diabetes mellitus, steroid use, and catheter placement sites in the ICU were associated with significantly higher risks of CAUTI. Multivariate analysis showed that prolonged catheterization (odds ratio [OR] 1.23, p = 0.002), diabetes mellitus (OR 5.87, p = 0.027), and catheter placement sites in the ICU (OR 6.12, p = 0.007) were independent risk factors for CAUTI. These results can serve as guidelines for optimal medical care in the ICU and also to achieve reduction in CAUTI rates.