台灣急性照護醫院的醫療照護相關感染與抗微生物藥物使用點盛行率調查之先驅研究

A Pilot Point-Prevalence Survey of Healthcare-Associated Infections and Antimicrobial Use in Acute Care Hospitals in Taiwan

歐盟於2010年起進行醫療照護相關感染與抗微生物藥物點盛行率調查。此研究乃根據歐盟疾病預防與管制中心之計畫書為參考，於2013年8月10日至31日調查台灣6家急性照護醫院之醫療照護相關感染及抗微生物藥物使用之點盛行率。2,491位住院病人中，有129（5.2%）位病人發生140次醫療照護相關感染，最常見的為肺炎與其它下呼吸道感染（35.0%），其次為泌尿道感染（23.6%），血流感染（15.7%）與外科部位感染（10.7%）。1,237（49.7%）位至少接受一種抗微生物藥物治療，共1,545筆抗生素。在1,545筆抗微生物藥物適應症中（包括治療、預防與適應症未明），37.0%用於治療社區得到的感染，15.1%用於治療醫院得到的感染，4.1%用於治療長照機構得到的感染，15.8%用於手術預防性抗生素，而於所有手術預防性抗生素中，其使用期間超過一天的佔70.5%。在用於治療的868筆抗微生物藥物中，31.9%用於肺炎與其它下呼吸道感染，20.7%用於泌尿道感染，6.7%用於血流感染，6.4%用於腹腔內感染。在所有科別中，加護病房（68.8%）、外科（63.5%）和內科（52.5%）有使用抗微生物藥物病人的比率高於兒科（30.8%）和婦產科（26.7%）。本研究成功地執行台灣急性照護醫院醫療照護相關感染點盛行率與抗微生物藥物使用之點盛行率調查，可評估醫療照護相關感染及抗微生物藥物使用的資訊，並提供監測方式的參考。

A point-prevalence survey (PPS) has been conducted annually by the European Union since 2010 to provide information regarding healthcare-associated infections (HAIs) and antimicrobial use. In this study, a PPS of HAIs and antimicrobial use was performed across 6 acute-care hospitals in Taiwan from August 10, 2013 to August 31, 2013. The PPS was carried out in accordance with the ECDC PPS protocol, version 4.3. Of 2491 surveyed patients in the 6 hospitals, 5.2% had an HAI, and 49.7% were receiving at least 1 antimicrobial agent. Among the 140 episodes of HAIs, pneumonia and other lower respiratory tract infections represented the most common type of HAI (35.0%), followed by urinary tract infection (23.6%), bloodstream infection (15.7%), and surgical site infection (10.7%). Among the 1545 instances of antimicrobial use, treatment for community-acquired infections accounted for 37.0%, treatment for hospital-acquired infections for 15.1%, and surgical prophylaxis for 15.8%. Moreover, 70.5% of the antimicrobial agents used for surgical prophylaxis were used for more than 1 day. Among the 868 cases of antimicrobial treatment, pneumonia and other lower respiratory tract infections were the most common reasons for the treatment (31.9%), followed by urinary tract infections (20.7%), bloodstream infections (6.7%), and intra-abdominal infections (6.4%). The percentages of patients using antimicrobial agents were higher in ICU (68.8%), surgery (63.5%), and medicine (52.5%), than in pediatrics (30.8%) and obstetrics/gynecology (26.7%). In conclusion, this study successfully surveyed the prevalence rate of HAI and antimicrobial use in acute-care hospitals in Taiwan. Continued implementation of the PPS should be promoted to analyze the burden of HAI and antimicrobial use, and to provide useful information for future policy-making and surveillance.