疥瘡病人出院後再度被診斷感染疥瘡的危險因子

Risk Factor of Scabies Infection Recurrence after Hospital Discharge

長期照護機構中，由於集中式的護理照顧方式，如果沒有完善的感染管制系統，容易導致疥瘡的擴散和群突發。本院設有特別病房，專門收治附近長期照護機構轉介的病人。臨床上常常看到某些疥瘡病人，出院後仍會再被診斷感染疥瘡。為了解哪些病人出院後特別容易再被診斷感染疥瘡，所以進行回溯性研究。從2006年1月1日到2009年12月31日，選取398個從安養中心轉介入此病房且感染疥瘡的病人。收案後，回溯性追蹤這些病人二年，發現有161個病人出院後於二年內再次被診斷感染疥瘡。利用Cox比例風險回歸模型，將病人住院時的各種可能的危險因子作回歸分析。結果發現，長期使用類固醇（風險比值：4.811；95%信賴區間：3.427～6.753；P值小於0.001）是這類病人出院後再被感染疥瘡最重要危險因子。除了儘可能避免長期使用類固醇外，針對這類病人需作更嚴格控管和治療，以減少再次被診斷感染疥瘡的機會。

Scabies infection has always been a major problem in long-term care facilities because centralized nursing without a good infection control system often leads to scabies outbreaks. Therefore, patients referred from long-term care facilities were admitted at a special ward in our hospital. In clinical settings, some scabies patients are often diagnosed with scabies infection recurrence after hospital discharge. In order to identify scabies patients prone to scabies infection recurrence after hospital discharge, we conducted a retrospective study. Between January 1, 2006, and December 31, 2009, 398 scabies patients were referred from long-term care facilities, of whom 161 were diagnosed with scabies infection recurrence within 2 years after hospital discharge. After applying the Cox proportional hazard regression model, long-term steroid use (hazard ratio: 4.811; 95% confidence interval: 3.427- 6.753) was identified as the most important risk factor of scabies recurrence after hospital discharge. According to the results, the scabies patients with long-term steroid use were prone to having a scabies infection recurrence. In addition to tapering the steroid dose, physicians should strictly control the infection and treat these patients to reduce their risk of developing a scabies recurrence.