長期照護機構中困難梭狀桿菌感染的感染管制策略

Strategies for Clostridioides difficile of Infection Control in Long-Term Care Facilities

困難梭狀桿菌感染(Clostridioides difficile infection, CDI)長期以來被視為是抗生素使用導致的問題，對人體造成傷害包括偽黏膜性大腸炎、毒性巨結腸、腸道穿孔等併發症。研究顯示困難梭狀桿菌感染的發病率相當高，尤其在醫療機構內更為突出。困難梭狀桿菌感染的復發率和死亡率也引起人們關注。影響困難梭狀桿菌感染風險的因素包括年齡、抗生素使用、質子幫浦抑制劑使用等。在長期照護機構中，困難梭狀桿菌感染傳播途徑主要是透過醫護人員和汙染環境，不必要的抗生素使用會增加困難梭狀桿菌感染的風險。實驗室診斷也非常重要，有症狀才採檢並做進一步的檢驗診斷。在長期照護機構中，適當的隔離措施至關重要，特別是對於有症狀的患者。解除隔離的時機應考慮症狀持續情況和機構的空間能力。，落實完善的接觸傳染預防與適當的環境清潔，才可有效的預防及控制困難梭狀桿菌感染傳播。

Clostridiodes difficile infection (CDI) has long been recognized as a significant consequence of antibiotic use, leading to serious patient complications such as pseudomembranous colitis, toxic megacolon, and bowel perforation. A 2011 study reported a high incidence of CDI in the United States, particularly within healthcare facilities. The recurrence and mortality rates associated with CDI have raised considerable concerns. Factors influencing the risk of CDI include age, antibiotic use, and proton pump inhibitor use. In long-term care facilities, the primary transmission routes for CDI are healthcare personnel and the environment. Unnecessary antibiotic use significantly increases the risk of developing CDI. Laboratory diagnosis of CDI is crucial only for patients exhibiting diarrheal symptoms. Implementing adequate contact precautions is vital in long-term care facilities, particularly for symptomatic patients. The timing of isolation release should consider the duration of symptoms and spatial capacity of the facility.