某矯正機關抗生素使用評估：強調治療皮膚與軟組織感染的抗生素的合宜性

Antibiotic Stewardship Program Emphasizing the Proper Treatment of Skin and Soft Tissue Infection in a Correctional Institute

台灣自西元2013(民國102年)年後，受刑人納入全民健康保險，矯正機關的醫療質量有大幅的提升。而矯正機關屬人口密集單位、傳染病容易在群體內傳播，也衍生出矯正機關的感染管制人才不足、抗藥性細菌滋長、及抗生素過度使用等問題。本研究探討本院所支援當地的某矯正機關門診，在2016年1月至2017年12月間總共看診58,767人次，有4,433(7.5%)有急性感染症的診斷，其中81.5%診斷為皮膚與軟組織感染。總共有150人次(3.4%)進行細菌培養，歸人統計共102人中，培養陰性為53人(52.0%)。皮膚與軟組織相關細菌培養者共33人中，抗甲氧苯青黴素金黃色葡萄球菌(MRSA)佔63.6%。共2,677人接受抗生素治療，平均每次療程11.5天，共接受13.2定義每日劑量(DDD)的抗生素。抗生素種類以amoxicillin及amoxicillin/clavulanic acid佔最多達59%，而可以對抗MRSA的藥物doxycycline、trimethoprim/sulfamethoxazole、fusidate只佔10.2%。以上結果顯示，矯正機關內之抗生素處方並未考量最常見的MRSA所致皮膚與組織軟組織感染，仍有改善的空間。

Correctional institutes have some health issues, included overcrowding, easy spread of transmissible diseases, lack of infection control personnel, overuse of antibiotics, and emergence of antibiotic resistance. These remained unaddressed until 2013, when prison inmates were granted the right to enroll in Taiwan’s National Health Insurance copayment program. This study explored the spectra of infectious diseases, causal pathogens, and approaches to treatment in a prison in Taoyuan. Between 2016 and 2017, the prison had 58,767 ambulatory visits. Antibiotics were given in 4,433 (7.5%) visits, 87.5% of the visits being for skin and soft tissue infections. One hundred fifty samples (3.4%) obtained from 102 patients were sent for culturing. Fifty-three (52.0%) showed negative growth. Thirty-three patients provided bacterial cultures for skin and soft tissue infections, with 63.6% of pathogens Methicillin-resistant Staphylococcus aureus (MRSA). Totally 2,677 inmates had received antibiotics, receiving 13.2 defined daily dose for an average of 11.5 days. Amoxicillin, amoxicillin/clavulanic acid made up 59% of antimicrobial prescriptions. Antimicrobials recommended for MRSA infections(e.g., doxycycline, trimethoprim/sulfamethoxazole, and fucidic acid)only made up 10.2%. In conclusion, healthcare professionals in this prison need updating regarding the choice of antibiotics available with particular attention paid to those more appropriately prescribed for MRSA-related skin and soft tissue infections.