某醫學中心人類免疫缺乏病毒感染病人之醫療照護相關感染

Analysis of Healthcare-Associated Infections among Human Immunodeficiency Virus-Infected Patients Admitted in a Medical Center

人類免疫缺乏病毒 （human immunodeficiency virus, HIV） 感染者由於免疫功能不全，發生醫療照護相關感染風險相對增加。本研究採回溯性研究，分析某醫學中心 2005~2013 年間人類免疫缺乏病毒感染病人發生醫療照護相關感染分布，結果：HIV 病人入院共 1,130 人次，發生 41 人次醫療照護相關感染，感染率為 3.63%；感染人次有逐年增加，但感染率無顯著上升趨勢 （p = 0.620，χ2 for trend）。感染個案以男性居多佔 85.4%，感染時病程已進展至 AIDS（acquired immunodeficiency syndrome） 者佔 92.7%，入院時出現伺機性感染者佔 73.2%，住院期間 CD4+T 細胞值小於 200 cell/mm3 佔 76.9%，感染前 7天曾發生休克 （血壓 < 90 mmHg） 佔 7.3%；常見感染部位前 3 名依序為血流感染 （41.5%）、泌尿道感染 （39%）、呼吸道感染 （12.2%）；感染菌種前 3 名分別為Acinetobacter baumannii （17.4%）、Escherichia coli （17.4%）、Staphylococcusaureus （13%）。進一步分析感染後 30 天內死亡預後之危險因子，單變項分析結果顯示具統計學上顯著差異之變項為休克及感染後住院天數 （p < 0.05）；多變項分析控制年齡、性別、感染後住院天數、伺機性感染、休克、CD4+T 細胞值、惡性淋巴瘤及加護病房等所有變項後均不具統計學上顯著差異 （p > 0.05）。結論：血流感染為 HIV 病人最常發生之感染部位；A. baumannii 及 E. coli 為最常見之感染菌種。"

Human immunodeficiency virus (HIV)-infected patients are at higher risk ofdeveloping healthcare-associated infections (HAIs) because of their weakenedimmune system. However, data on the occurrence of HAIs in HIV-infected patientsare limited. This study aimed to analyze the incidence and epidemiology of HAIs inthis population.A retrospective study was conducted on all HIV-infected patients admitted to amedical center in Taiwan from 2005 to 2013. A univariate analysis was performedusing a chi-square or Fisher’s exact test. A multiple analysis was performedusing logistic regression model to assess the potential risk factors and prognosticindicators of HAIs.During the study period, about 1,130 HIV-infected patients were admitted,and 41 episodes of HAI (3.6% per admission) were identified in 30 patients. Theincidence of HAI slightly increased every year (p = 0.620; chi square test for trend).The proportional frequencies of HAIs were as follows: 17 bloodstream infections,41.5%; 16 urinary tract infections, 39%; 5 respiratory tract infections, 12.2%; 1 skininfection, 2.4%; 1 gastrointestinal tract infection, 2.4%; and 1 venous infection,2.4%. The most common pathogens were Acinetobacter baumannii (17.4%),Escherichia coli (17.4%), and Staphylococcus aureus (13%). The mortality rate ofHAI was 46.7%. Shock (BP < 90 mmHg) and the length of postinfection stay weresignificantly associated with death (p < 0.05). Bloodstream infections were the most frequent infection by site. HAIs wereassociated with a high mortality rate. A. baumannii and E. coli were the leadingpathogens responsible for HAIs. Shock and the length of postinfection stay wererelated risk factors of mortality.