某醫學中心新生兒加護病房院內感染 Enterobacter species 菌血症流行病學調查

Epidemiology and Risk Factors for Nosocomial Enterobacter Bacteremia at Neonatal Intensive Care Unit in a Medical Center

Enterobacter species 菌血症近幾年有增加的趨勢，特別是在新生兒加護病房，但是針對新生兒加護病房病嬰發生 Enterobacter Spp. 菌血症之相關危險因子的研究並不常見。本研究利用回溯性病例對照法，收集2001-2007年住在某醫學中心新生兒加護病房，發生 Enterobacter Spp. 菌血症感染為個案組共49人，以每一個個案配對兩名轉入日前後相差2週、同住在新生兒加護病房超過48小時未發生院內感染的病嬰作為對照組。研究結果發現 Enterobacter Spp. 菌血症分離率由2001年26%逐年增加至2007年的75%，其中以 Enterobacter cloacae 最常見；感染密度為1.58‰至3.41‰，經卡方檢定趨勢分析各年度間發生 Enterobacter Spp. 菌血症之感染密度並無顯著差異（p=0.09）。單變項檢定發現兩組間具統計上顯著差異（p<0.05） 之變項，在病人屬性方面包括：出生過敏、出生體重、及出生第一分鐘平均 Apgar score、轉入時的病情嚴重度、曾哺餵母乳、新生兒加護病房停留和總住院天數以及死亡率等；侵入性處置或治療方面則有使用氣管內管、中心靜脈導管、動脈導營、腸道外營養輸和廣效抗生素等。經多變項邏輯迴歸分析發現使用中心靜脈導管與腸道外營餐輸液是發生 Enterobacter spp. 菌血症的顯著危險因子（p<0.05）。結論：Enterobacter spp. 菌血症有增加趨勢，但無統計上顯著差異；而中心靜脈導管和腸道外營養輸液是顯著危險因子。建議臨床在照護與執行此相關侵入性措施應特別注意無菌操作原則，並落實接觸病患前後洗手，減少移生菌污染週遭環境，方可有效減少病嬰受感染的危險。（感控雜誌 2009; 19: 81-9）。

Nosocomial infections and outbreaks caused by Enrerobacter have been reported elsewhere at hospitals, including neonatal intensive care units (NICUs) . However, risk factors of acquisition of Enterobacter bacteremia in NICU had less been investigated. To understand the epidemiology and risk factors of nosocomial bacteremia caused by Enterobacter species at NICU, we performed a case-control study in a medical center from 2001 to 2007. Totally forty-nine patients had Enterobacter bacteremia, accounted for 37% of all bacteremia at NICU during the study period. The most common isolated specie was Enterobacter cloacae. The prevalence of Enterobacter bacteremia had been increased from 26% in 2001 to 75% in 2007, with the infection density increased from 1.58 to 3.41 episodes per 1000 patient-days, respectively. By logistic regression, central venous catheterizations (odds ratio [OR], 3.15; 95% confidence interval [95% CI],1.02-9.67) and use of parenteral nutrition (OR, 14.0 ; 95% CI, 3.07-63.75) were two independent factors associated with Enterobacter bacteremia. In conclusion, our results revealed that aseptic techniques before medical interventions, vigorous intravenous line nursing care and hand washing are important measu.res to prevent Encerobacrer bacteremia at NICUs. (Infect Control J 2009;19:81-9).