放置導尿管患者發生泌尿道感染之相關因子分析

Associated Factors Related to Urinary Tract Infection in Patients with Indwelling Urinary Catheterization

臨床侵入性導管及治療處置，讓病人的生理徵象指標得以被掌控，但也引發不少醫療問題，其中較為嚴重的即為醫療照護相關感染。在台灣，醫療照護相關感染最常見的為泌尿道感染，過去研究指出約有15～25%急性病房患者插導尿管，而產生導管相關泌尿道感染（catheter associated urinary tract infections, CAUTI）的患者佔所有醫療照護相關感染的31%。當導尿管置入一週後大約有20%的患者會引發菌尿症，在這些菌尿症病患中約有四分之一患者會出現嚴重症狀，可見CAUTI是相當值得重視的議題。本研究使用2004～2005年之全民健保資料庫資料，探討CAUTI之風險因子：研究結果顯示，不論有無住加護病房，男性罹患CAUTI之風險較低（OR=0.527~0.736, P<0.05），年齡層越高者，其風險越高（OR=1.410~5.731, P<0.05）。再細分為：（1）「曾住加護病房」者，主診斷為內分泌及新陳代謝類者，其罹患CAUTI之風險較高（OR=17.741, P<0.05），而合併症數越多、科別為外科、層級別為醫學中心與權屬別為公立，其風險則較低（OR=0.847 0.490 0.597 0.932, P<0.05）。（2）「住一般病房」者，主診斷為出生前後期間相關疾病、科別為內科及權屬別為公立，發生CAUTI之風險較高（OR=11.715 1.523 1.150, P<0.05）。本研究結果能提供後續研究及臨床工作者，未來在病人照護或感染管制上的參考建議，進而達到醫療品質的改善。

The progress of medical technology has enabled better control of patients’ vital signs. However, the progress is also related to some problems, one such important problem being nosocomial infections. The most common healthcare-associated infection in Taiwan is urinary tract infection. A previous study has shown that catheter-associated urinary tract infection (CAUTI) accounted for 31% of all healthcare-associated infections. The aim of this study was to investigate the factors influencing the risk of CAUTI development for hospitalized patients with urinary catheters. We used data from Taiwan’s National Health Insurance Research Database of 2005-2006. By using stepwise logistic regression, we found that female patients and patients with advanced ages were at a higher risk of developing CAUTI than the other patients were. Comorbidities, hospitalization mainly for endocrine and metabolic diseases, admission to the specialty “others”, and hospitalization in district or public hospitals were associated with a higher risk of CAUTI development in patients admitted to intensive care units (ICUs). In contrast, a main diagnosis of “certain conditions originating in the perinatal period”, admission to the internal medicine specialty, and admission to regional hospitals were associated with a higher risk of CAUTI development in non-ICU patients. The results of our study provide basic information for improving the quality of medical care.