某醫學中心萬古黴素抗藥性腸球菌之醫療照護相關感染趨勢及危險因子分析

Trends and Risk Factors for Healthcare-Associated Infections by Vancomycin-Resistant Enterococci in a Medical Center in Northern Taiwan

過去二十年醫療照護相關萬古黴素抗藥性腸球菌（vancomycin-resistant Enterococci, VRE）感染在世界各國有逐年上升趨勢，依據衛生福利部疾病管制署資料顯示，VRE醫療照護相關感染在台灣也逐年增加。本研究藉由台灣北部某醫學中心，病人於2009年1月至2013年12月間住院，因醫療照護相關感染且菌株為腸球菌者病人納入研究對象，依其感染時所住之病房屬性區分為一般病房或加護中心，性別、年齡、潛在疾病以及感染前48小時內是否有使用侵入性導管裝置等變項，進行單變項、多變項羅吉斯迴歸分析，探討各變項間VRE感染之危險因子。研究結果顯示：2009至2013年間，VRE感染有逐漸上升趨勢；控制其他變項因子後，VRE感染危險因子有肝硬化（P＜0.01）、全靜脈營養輸液（P=0.03）或鼻胃管置放（P＜0.01）。因此臨床照護遇有肝硬化、鼻胃管置放或使用全靜脈營養輸液之病人，應減少非必要之侵入性管路使用、確實環境清消及執行手部衛生。

A worldwide increase in the incidence of healthcare-associated infections (HAIs) caused by vancomycin-resistant Enterococci (VRE) has been noted over the last two decades. In addition, the number of HAIs caused by VRE has also risen in Taiwan in the past decade. This study was conducted from January 2009 to December 2013 at a medical center in northern Taiwan. Patients with HAI episodes caused by Enterococci were identified, and their clinical and laboratory data were retrieved from medical records. The variables investigated included ward type, age, sex, underlying disease, and use of an invasive catheter device less than 48 h prior to infection. Statistical analyses, including, univariate and multivariate logistic regression were performed to assess the risk factors contributing to VRE infections. The results showed that VRE infections have increased from 2009 to 2013. Factors associated with VRE infections after controlling for other variables were liver cirrhosis (P < 0.01), total parenteral nutrition (P = 0.03), and nasogastric tube placement (P < 0.01). More stringent hand hygiene procedures, environmental cleaning and decreasing invasive devices for patients with liver cirrhosis, nasogastric tube placement, and those receiving total parenteral nutrition should be implemented.