安養機構住民入院時帶有多重抗藥性細菌的狀況：中部某醫院的細菌監測報告

A Surveillance Study of High Antimicrobial Resistance of Bacterial Isolates from Nursing Home Residents Admitted to a Regional Hospital

安養機構住民年紀較大，同時具有許多慢性疾病，經常有住院或就診的需求，也經常被開立抗生素，而這些都是多重抗藥性微生物感染的危險因子。本研究以回溯方式對2019年1月1日到2021年12月31日來自住宿型安養院住院者的細菌學結果加以分析，探討特定抗藥性細菌在安養機構的流行樣態。研究收集來自93間安養院共1557人次的住民因醫療需求住院，微生物臨床檢體共5217件，其中1535 (29.4%)件檢體有培養分離出微生物。前五位分別是Escherichia coli (n=375; 24.4%)、Klebsiella pneumoniae (n=199; 13%)、Pseudomonas aeruginosa (n=136; 8.9%)、Proteus mirabilis (n=118; 7.7%)與Staphylococcus aureus (n=111; 7.2%)。分離出來的E. coli菌株中帶有碳青黴烯抗藥的比率為5%，K. pneumoniae碳青黴烯抗藥的比率為51%，P. aeruginosa為24%。MRSA在所有金黃色葡萄球菌中占91%，enterococci中VRE占比則為14.3%。Acinetobacter baumannii是第六常見的分離菌種，而CRAB的比率為88%。血液檢體中的E. coli，其碳青黴烯抗藥比率在2019與2020年為0%，但2021年則上升為11.8%。
本研究顯示有住院需求的住宿型安養院住民帶有多重抗藥性細菌移生的情況已經相當嚴重，如何減緩抗藥性細菌在機構內的可能傳播，並且避免抗藥性細菌的群聚感染的發生，值得進一步重視與研究。

Multidrug-resistant organisms (MDROs) are a major public health concern worldwide. Nursing home residents are at a high risk of MDROs infection because of old age, disabilities, comorbidities, frequent hospitalization, and antibiotic consumption. Once infected, antibiotic therapy is extremely limited and may also cause death. Surveillance of high antimicrobial resistance of bacterial isolates from nursing home residents could provide important clinical information for further infection control in hospitals and long-term care facilities. However, the prevalence of MDROs in nursing home residents has rarely been reported in Taiwan. Therefore, the present study aimed to investigate the prevalence of MDROs colonization among this population.
This retrospective study was conducted at a regional hospital between January 2019 and December 2021. Microbiological results were collected from nursing home residents who were admitted to our hospital during this period. Microbiological samples collected within 72 hours of admission were included in the study. Results: A total of 5,217 clinical microbiological samples were collected in 3 years, including 1,535 bacterial isolates.
The most commonly isolated bacteria were Escherichia coli (n=375, 24.4%), Klebsiella pneumoniae (n=199, 13%), Pseudomonas aeruginosa (n=136, 8.9%), Proteus mirabilis (n=118, 7.7%), and Staphylococcus aureus (n=111, 7.2%). The incidences of carbapenem resistance (CR) among various isolates were 5%, 51%, f24%, and 88% for E. coli, K. pneumoniae, P. aeruginosa, and A. baumanii, respectively. Moreover, no CR for P. mirabilis isolate was observed. Furthermore, 91% of S. aureus isolate was methicillin resistant, and 14.3% of enterococci were vancomycin resistant. Overall, 15.1% of Enterobacteriaceae isolate was resistant to carbapenems. We also observed a rapid increase in the rate of CR for E. coli isolates from 0% in 2019–2020 to 11.8% in 2021in the samples.
The prevalence of CR for E. coli, K. pneumoniae, P. aeruginosa, and A. baumanii, MRSA, and VRE was significantly higher among hospitalized nursing home residents. Therefore, infection prevention and control strategies to reduce MDROs in nursing homes are critical. Universal precautions should be encouraged when these patients require medical care.