推動黏膜屏障損傷檢驗證實血流感染定義後中心導管相關血流感染之流行病學與臨床特徵分析

惡性腫瘤病人發生中心導管相關血流感染（central line associated bloodstream infections, CLABSIs）被認為主要與口腔或腸道黏膜破損病原菌進入血流系統有關。臺灣自2018年納入MBI-LCBI監測尚無相關分析報告；本研究探討某醫學中心導入MBI-LCBI監測後CLABSIs變化，並比較MBI-CLABSIs（mucosal barrier injury-central line-associated bloodstream infections）和Non-MBI-CLABSIs（non-mucosal barrier injury-central line-associated bloodstream infections）病人屬性分布。回溯調查2018年1月至2023年12月發生CLABSIs共3,703人次，其中MBI-CLABSIs共194人次，感染密度0.20‰，排除MBICLABSIs後CLABSIs密度僅減少約5%。MBI-CLABSIs最常見的病原菌前三名分別為Escherichia coli 31.4%、Klebsiella pneumoniae 28.7%和Enterococcus faecium 14.8%。此外，MBI-CLABSIs病人有較高比例留置永久性中心導管、感染革蘭氏陰性菌、惡性腫瘤、化療治療，白血球低下（neutropenia）、年齡較輕、住加護病房和死亡比例較低，均達統計顯著差異（p<0.05）。本研究分析MBI-LCBI監測對CLABSIs流行病學相關變化，結果顯示對整體CLABSIs影響不大，為預防醫療照護中心導管相關血流感染，各項感染管制措施仍具重要性。

Patients with cancer are often diagnosed with central venous catheter-associated bloodstream infections (CLABSIs) owing to pathogens from mucosal damage in the mouth or intestines. Since Taiwan adopted“Mucosal Barrier Injury Laboratory- Confirmed Bloodstream Infections (MBI-LCBI)”in 2018, no local analysis reports have been made. The present study examines the effects of MBI-LCBI surveillance on CLABSI rates at a medical center from January 2018 to December 2023. Of 3,703 CLABSI cases, 194 were MBICLABSIs, with an infection density of 0.20%. Excluding MBI-CLABSIs, the density of CLABSIs decreased by approximately 5%. The most common MBI-CLABSI pathogens were Escherichia coli (31.4%), Klebsiella pneumoniae (28.7%), Enterococcus faecium (14.8%), Candida tropicalis (4.5%), and Enterobacter cloacae (3.6%). MBI-CLABSI cases showed significant differences from non-MBI-CLABSI cases in catheter retention, Gram-negative bacteria, diagnoses, chemotherapy, and neutropenia. MBI-CLABSIs were linked to younger age, fewer ICU admissions, and lower mortality rates. Collectively, this study highlights the minimal impact of MBI-LCBI on overall CLABSI rates and emphasizes the need for continued CLABSI prevention efforts.