南部某區域醫院中心導管組合式照護介入措施對醫療照顧相關血流感染與致病菌變化分析

Analysis of the trends and causative pathogens of healthcare-associated bloodstream infections after implementation of central line bundles at a regional hospital in southern Taiwan, 2008-2017

本研究採回溯性觀察研究設計，收集2008至2017年間南部某區域醫院住院病人醫療照護相關血流感染資料，本院於2013年起推動中心導管組合式照護，研究目的探討本院中心導管組合式照護介入措施對醫療照護相關血流感染率和致病菌變化。研究結果顯示2008至2017年醫療照護相關血流感染密度為0.79‰。研究前期（2008～2012）相較後期（2013～2017）醫療照護相關血流感染密度有下降的趨勢（0.91‰vs. 0.67‰），其相對風險為0.73倍（95％ CI: 0.66～0.79）。整個研究期間之醫療照護相關血流感染致病菌株共2,090株，革蘭氏陰性菌最常見（53.1％），次為革蘭氏陽性菌（36.4％）和念珠菌（8.8％）。血流感染最常分離的菌種依序為coagulase negative staphylococci（CoNS）（19.3％）、Staphylococcus aureus（8.7％）、Escherichia coli（8.2％）、Acinetobacter baumannii（8.1％）及Klebsiella pneumoniae（6.0％）。中心導管組合式照護對醫療照護相關血流感染致病菌影響，發現革蘭氏陽性菌下降最多，降幅4％，相對風險為0.59倍（95％ Confidence Interval [CI]: 0.52～0.69）。菌種分析以金黃色葡萄球菌S. aureus下降最多，相對風險為0.56（95％ CI: 0.41~0.76）。總結中心導管組合式照護介入措施降低醫療照顧相關血流感染且革蘭氏陽性菌下降明顯。（感控雜誌2020:30:167-178）

This retrospective study aimed to determine the rate of healthcare-associated bloodstream infection (HABSI) that occurred at a regional hospital in southern Taiwan during 2008~2017. A central venous catheter (CVC) bundle was implemented in 2013. The results indicated that HABSI incidence was 0.79 per 1000 inpatient days during the study period. Furthermore, the incidence density of HABSI decreased from 0.91% in T1 (2008~2012) to 0.67% in T2 (2013~2017) with an incidence density ratio of 0.73 (95% CI: confidence interval [CI]: 0.66~0.79). In the study period, 2,090 cases of HABSI were detected, and 53.1% of HABSI were caused by gram-negative bacteria, followed by gram-positive bacteria (36.4%) and Candida species (8.8%). The most common organisms causing HABSI were coagulase-negative staphylococci (19.3%), Staphylococcus aureus (8.7%), Escherichia coli (8.2%), Acinetobacter baumannii (8.1%), and Klebsiella pneumoniae (6.0%). We compared the difference in bacteria that caused HABSI between the two study periods. We observed that the incidence of gram-positive infections decreased from 0.44% to 0.27% with an incidence density ratio of 0.59 (95% CI: 0.52~0.69), while the incidence of gram-negative infections and Candida infections decreased from 0.59% to 0.45% and from 0.10% to 0.07% with incidence density ratios of 0.75 (95% CI: 0.67~0.85) and 0.67 (95% CI: 0.50~0.90), respectively. The reduction in the HABSI incidence at our institution coincided with the implementation of the CVC bundle. Moreover, there was a significant decrease in the proportion of gram-positive infections in the post-intervention period. Therefore, the implementation of a CVC care bundle was associated with a reduction in HABSI at a regional hospital.