沈默的疫情--台灣抗生素抗藥性問題暨感控人力現況

A Silent Epidemic--The Problem of Antimicrobial Resistance in Taiwan and the Current State of Manpower for Infection Control

台灣在新冠肺炎疫情期間，部分抗藥性細菌盛行率（年增加比率）暴增3倍。新冠肺炎疫情再次凸顯感染症專科醫師在抗疫第一線所扮演的吃重角色與重要性，但感染症醫學領域發展與人才培育之國家政策卻相對貧乏，進而導致感染症專科醫師報考人數連年下滑。未來感染症專科醫師人數持續匱乏，可能導致抗生素抗藥性攀升。台灣醫院感染管制與抗藥性監測管理系統(THAS) 2022年報表顯示，區域醫院的抗藥性相較於醫學中心有更大幅的增加，其原因推測與國外一致是因為感染管制團隊投入防疫，已無餘力進行抗生素管理(AMS)及其他相關的感染症議題。台灣感染症醫學會及台灣感染管制學會希望透過引進個案管理量表與強化抗生素管理策略之應用，提升創新及高度管制性藥品使用之跨團隊整合，系統性地建構抗生素管理組織架構，透過精準診斷、即時治療，並強化用藥多元化策略，以降低抗生素抗藥性。在後疫情時代，將抗菌藥物使用暨抗藥性照護量表納入健保支付項目，預期可撙節醫療資源支出，以達經濟效益並能盡早部署，因應未來的隱形戰疫抗藥性危機。

During the COVID-19 pandemic in Taiwan, the prevalence rate (annual rate of increase) of some drug-resistant bacteria tripled. The COVID-19 pandemic has once again highlighted the important role and importance of infectious disease specialists on the frontline of the fight against the pandemic. However, the national policy for the development of infectious disease medicine and personnel training is relatively poor, which has resulted in an increasing number of infectious disease specialists applying for examinations year after year. The continual shortage of infectious disease specialists may have led to an increase in antibiotic resistance. The 2022 report of the Taiwan Hospital Infection Control and Drug Resistance Surveillance Management System showed that drug resistance has increased significantly in regional hospitals compared to medical centers. There is no additional capacity for antimicrobial stewardship or other related infectious disease programs. The Infectious Diseases Society of Taiwan and the Infection Control Society of Taiwan hope that by introducing case management scales and strengthening the application of antibiotic management strategies, the cross-team integration of innovative and highly regulated drug use will be improved and the organizational structure of antibiotic management will be systematically constructed. Immediate treatment and strengthening of drug diversification strategies are required to reduce antibiotic resistance.
In the post-pandemic era, incorporating antimicrobial drug use and antimicrobial resistance care scales into health insurance payment items is expected to reduce medical resource expenditure and achieve economic benefits. This should be deployed as early as possible to cope with the future antimicrobial drug resistance crisis.