某區域教學醫院醫療照護相關多重抗藥性鮑氏不動桿菌感染危險因子分析

Risk Factors of Healthcare-Associated Multidrug-Resistant Acinetobacter Baumannii Infection

鮑氏不動桿菌（Acinetobactor baumannii）醫療照護相關感染在國內醫療院所相當常見。鮑氏不動桿菌能在環境長時間存活，並且容易產生多重抗藥性。根據台灣院內感染監測系統（Taiwan Nosocomial Infections Surveillance System, TNIS）2011年資料顯示，醫學中心及區域醫院加護病房carbapenem-resistant A. baumannii比例從2003年的小於20%，逐年上升至2011第三季70%以上。由於醫療照護相關感染牽涉病人安全，增加死亡率和醫療成本支出，因此找出相關危險因子並制定介入措施相當重要。本研究在某區域教學醫院2008年至2011年間，以回溯性病例對照研究法（病例組：對照組=1：4配對），分析多重抗藥性鮑氏不動桿菌（multidrug-resistant A. baumannii, MDRAB）醫療照護相關感染之危險因子。研究結果顯示：以多變項conditional logistic regression調整其他因子的作用後，支氣管鏡檢查（adjusted odds ratio [OR]: 5.8, P = 0.003）、使用ceftazidime (adjusted OR: 4.3, P = 0.03)、使用cefpirome（第四代Cephalosporin類抗生素）（adjusted OR: 3.7, P = 0.03）、及住院天數（adjusted OR: 1.1, P = 0.002）為醫療照護相關MDRAB感染之獨立危險因子。本研究結論為：加強侵入性檢查設備清潔消毒及管制廣效抗生素使用為預防MDRAB醫療照護相關感染重要的環節。

Healthcare-associated infections (HAIs) by Acinetobacter baumannii are a common problem in Taiwan. A. baumannii can survive environmental desiccation and also frequently develop antimicrobial resistance. Taiwan Nosocomial Infections Surveillance data shows that the percentage of carbapenem-resistant A. baumannii in intensive care units of medical centers/regional hospitals has increased from less than 20% in 2003 to 70% in the third quarter of 2011. Because of the excess mortality and medical costs associated with A. baumannii HAIs, it is imperative to identify the associated risk factors. This study aimed to investigate the risk factors of multidrug-resistant A. baumannii (MDRAB) HAIs from 2008 to 2011 in a regional teaching hospital using a case-control study (case:control=1:4). Multiple conditional logistic regression analysis showed that, after adjusting for effects of other variables, bronchoscopy (adjusted odds ratio [OR]: 5.8, P=0.003), use of ceftazidime (adjusted OR: 4.3, P=0.03) and fourth-generation cephalosporins (adjusted OR: 3.7, P=0.03), and days of hospitalization (adjusted OR: 1.1, P=0.002), are independent risk factors for MDRAB HAIs. We conclude that meticulous cleansing of invasive procedure equipment and prudent use of board-spectrum antibiotics are essential components for controlling MDRAB HAIs.