加護病房 Acinetobacter baumannii醫療照護相關感染之影響因素

Factors Influencing Healthcare-associated Infections with Acinetobacter baumannii at Intensive Care Units

本前瞻性研究之目的為探討加護病房病入發生鮑氏不動桿菌（Acineto-bacter baumannii）醫療照護相關感染之相關因素。以某醫學中心2007年至2008年期間住加護病房之病人為研究對象，但排除住加護病房未滿48小時者。結果：研究對象共2，987入，鮑氏不動桿菌感染有68入，每千人日有3.4件感染；對imipenem具有抗藥性者佔14.7%；主要感染部位是呼吸道感染（39.7%）、血流（30.9%）、尿路（13.2%）、手術部位（11.8%）、以及其他部位（4.596）。以邏輯氏迴歸分析控制其他影響因素後，仍具統計學上顯著差異（p<0.05）者，包括年齡（勝算比1.01，95%信賴區間1.01-1.05）、感染前住加護病房天數（勝算比1.02，95%信賴區間1.01-1.06）；轉住入加護病房前使用抗生素（勝算比2.28，95%信賴區間1.26-4.11）；使用呼吸器（勝算13.82，95%信賴區間5.25-29.39）；留置導尿管（勝算比6.77，95%信賴區間3十1478）、放置鼻胃鼻（勝算比11.61，95%信賴區間3.63-29.19）。結論：鮑氏不動桿菌醫療照護相關感染以呼吸道最多；所有鮑氏不動桿菌感染者與多項侵入性導管的使用具有顯著關聯性。因此，醫護入員應遵循各項感染管制措施，尤其是落實導管之照護是預防鮑氏不動桿菌感染與散播的重要策略。

The purpose of this prospective study was to detect the factors influencing healthcare-associated infections (HAIs) with Acinetobacter baumannii in intensive care units (ICUs). All the patients admitted to the ICUs in a medical center from 2007 to 2008 were eligible for the study. Patients who spent less than 2 days in the ICUs were excluded from the study. Results: A total of 68 patients were diagnosed with A. baumannii HAIs. The incidence density was 3.4. Among the diagnosed patients, the rate of imipenem resistance was 14.7%, The most common infection sites were the respiratory tract (39.7%), followed by the bloodstream (30.9%), urinary tract (13.2%), surgical site (11.8%), and others (4.5%). The covariates in logistic regression analysis were adjusted, and the age (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.01-1.05); length of stay in the ICU before HAI (OR, 1.02; 95% CI, 1.01-1.06); antibiotics administered before admission to the ICU (OR, 2.28; 95% CI, 1.26-4.11); and the use of mechanical ventilators (OR, 13.82; 95% CI, 5.25-29.39), urinary catheters (OR, 6.77; 95% CI, 3.1-14.78), and nasogastric tubes (OR, 11.61; 95% CI, 3.63-29.19) were determined as independent risk factors. Conclusions: The most common A. baumannii HAIs were the respiratory tract infections. Good infection control practices, especially good care of catheter-associated equipment, may be an important strategy for preventing infections with A. baumannii and their spread in the hospital.