| 中文摘要 |
醫療照護相關感染會造成醫療資源花費增加且延長病人住院天數，抗碳青黴烯之克雷伯氏肺炎桿菌(carbapenem-resistant Klebsiella pneumoniae, CRKP)是醫院醫療照護相關感染常見的carbapenem抗藥性菌種之一。加護病房病人多因疾病有侵入性治療行為，所以醫療照護相關感染比一般病房發生率高，故CRKP感染遂成為重症照護單位感染管制的重要課題之一。本研究是中區某區域教學醫院，彙整2018年至2020年，3年期間內入住加護病房病人進行篩檢糞便CRKP者，其全程住院期間、後續轉出加護病房病人糞便及臨床檢體血液培養出CRKP之發生率進行分析。由於病人一旦發生菌血症，住院天數、醫療成本與死亡率更是增加數倍，所以本研究CRKP的檢體範圍限縮在血液及糞便篩檢的培養，在分別三年的資料中，發現每年約有三千多名病人人數，其總開立檢驗數達一萬多筆，亦即平均每人檢驗次數高達3.5次。另外，資料顯示單一病人開立10次以上檢驗次數者三年來有393人，佔總開立數6,166次，約佔三年總檢驗數20%。統計資料顯示，病人糞便培養出CRKP，在未介入任何積極處置或腸道除菌的狀況下，後續檢體仍可以檢驗出CRKP，短時間之內不會陰轉，但這類病人可能會因為頻繁轉換病房需要反覆篩檢。且病人之後發生CRKP菌血症的機會並沒有因為CRKP的腸道移生而明顯增加。所以病人在病房間的轉出、入的篩檢只是增加醫院的檢驗成本，醫院應該以更有效的管控機制來因應CRKP在院內的流行。 |
| 英文摘要 |
Healthcare-associated infections can cause an increase in the cost of healthcare resources and prolong the length of hospitalization [1]. Carbapenem-resistant Klebsiella pneumoniae (hereafter referred to as CRKP) is one of the drug-resistant strains of bacteria that are commonly associated with infections in hospitals during healthcare [2, 3]. Patients staying in the intensive care units (ICUs) often receive invasive procedures, and the incidence of healthcare-associated infections is higher than those in general wards [4, 5]. Thus, CRKP infections have become one of the most important issues in infection control in intensive care units. This study was conducted at a regional teaching hospital in Central Taiwan from 2018 to 2020.. The incidence rate of CRKP was analyzed by compiling the results of fecal CRKP screening and the fecal and clinical blood cultures of the patients during the hospitalization period. The length of hospitalization, medical cost and mortality rate increase several times once CKE bacteremia occurs [5]. The data collection of this study was limited to blood and fecal culture to elucidate the association between these to parameters. During the 3-years study period, we found that more than 3,000 patients, and more than 10,000 fecal sample were ordered with CRKP screening test each year, which means that the average number of tests per patient was as high as 3.5. In addition, the data showed that 393 patients had more than 10 tests performed on a single patient in the past three years, accounting for a total of 6,166 tests performed, or about 20% of the total number of tests performed in those three years. Data showed that CRKP detected in stool samples persisted for a long period of time without intervention. These patients may receive repeated screening test due to frequent transfer between wards. There was no significant increase in the likelihood of subsequent CRKP bacteremia due to intestinal migration of CRKP. Therefore, the unnecessary screening tests of patients only increase the cost of hospitals. Hospitals should take more effective measurements to respond to the CRKP dissemination in hospitals. |
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