長期照護機構內住民感染的監測定義：重新檢視McGeer準則

Definitions of Infections for Surveillance in Long-term Care Facilities: Revisiting the McGeer Criteria

自從1991年McGeer等人發表適用於長期照護機構內住民感染監測定義準則後，至今已沿用二十餘年未修訂。此次準則依結構性實證文獻回顧來凝聚專家共識以修訂定義。泌尿道感染及呼吸道感染有大幅修訂，腸胃道感染新加上諾羅病毒及困難梭狀桿菌兩種感染定義。由於老年人感染症狀表現非特異且不典型，因此本修訂準則與美國感染症學會於2009年公布之長期照護機構高齡住民發燒及感染評估準則一致。另外譫妄及急性功能衰退，也是住民感染構成條件。

In the more than two decades since McGeer et al. proposed definitions of infection for surveillance in long-term care facilities (LTCFs) in 1991, these definitions have not been updated. In this report, an expert consensus panel modifed these defnitions based on a structured literature review. The criteria used to define urinary and respiratory tract infections were significantly revised. New gastrointestinal infection defnitions were added for norovirus gastroenteritis and Clostridium diffcile infections. The defnition of fever was modified to be consistent with the 2009 Infectious Diseases Society of America guidelines for evaluating fever and infection in older adults residing in LTCFs. The additional criterion “acute change in mental status or acute functional decline” was also included.