2011-2022年北部某醫學中心醫療照護相關血流感染之長期趨勢

Trend of Healthcare-Associated Bloodstream Infections at a Medical Center in Northern Taiwan, 2011-2022

醫療照護相關血流感染相較於其他感染，會造成更高比例的併發症與死亡。此研究旨在評估推動醫療照護血流感染改善專案，對於中心導管相關血流感染發生率與菌種分佈之長期影響。北部某醫學中心自1981年開始，進行前瞻性全院性醫療照護相關感染監測，監測之感染部位以血流感染為主，且逐年增加。因此推動一系列改善專案。本單一醫院研究回溯性分析2011年1月1日至2022年12月31日，全院醫療照護相關血流感染率之趨勢及菌種分布，並區分加護病房及一般病房。2011-2022年間之醫療照護相關血流感染率趨勢，於全院及一般病房維持平穩，而於加護病房則呈現下降趨勢；加護病房之醫療照護相關血流感染2011年為6.68‰，2022年則下降至5.34‰（p<0.0001）。醫療照護相關血流感染菌種分析顯示，2020-2022年間以革蘭氏陰性菌及腸道菌屬為主；相較於2011-2013年間，2020-2022年間Staphylococcus spp.所造成之血流感染顯著減少，而Enterococcus spp.、Klebsiella pneumoniae、Enterobacter spp.、Burkholderia cepacia complex所造成之血流感染顯著增加。推動醫療照護血流感染改善專案，於加護病房能顯著減少醫療照護相關血流感染率，尤其對於降低皮膚菌叢導致的中心導管相關血流感染成效良好。未來應持續推動醫療照護血流感染改善專案，以避免醫療照護相關血流感染。

Healthcare-associated bloodstream infections are associated with higher rates of morbidity and mortality compared with other infections. The study aimed to evaluate the long-term effect of implementing infection prevention and control (IPC) programs on the incidence density and microbiologic distribution of healthcareassociated bloodstream infections. A medical center in northern Taiwan had been following international guidelines for the surveillance and management of healthcare-associated infections (HAIs) since 1981. A retrospective study was conducted from January 1 2011 to December 31 2022. to include all healthcare-associated bloodstream infections. The trend in the incidence density of healthcare-associated bloodstream infection was analyzed, and a comparison was made between the microbiologic distribution of pathogens identified during 2011-2013 and 2020-2022. The active HAI surveillance and periodic feedback led to a significant reduction in the incidence density of healthcare-associated bloodstream infections in intensive care units (ICUs) from 2011 to 2022 (6.68 vs 5.34 episodes per 1000 patient-days, p <0.001). During 2020-2022, Gram-negative bacteria of gut origin were the most frequently identified pathogens. Compared with the microorganisms identified during 2011-2013, there was a significant decrease in Staphylococcus spp. and a significant increase in Enterococcus spp., Klebsiella pneumoniae, Enterobacter spp., and Burkholderia cepacia complex during 2020-2022. The implementation of IPC programs had a positive impact on reducing healthcare-associated bloodstream infections in ICUs, particularly those caused by skin-related organisms. Our research reinforces the importance of maintaining the IPC program to prevent healthcare-associated bloodstream infections.