Clinical Features of Extended-Spectrum Beta-Lactamase-Producing Organisms Colonized in Patients Prior to Admission to a Respiratory Intensive Care Unit

呼吸加護病房中殖生產生廣效性乙內醯胺酶菌種的病人其臨床型態

蔡慶宏(Chin-Hung Tsai) ； 惠群(Chun Hui) ； 吳杰亮(Chieh-Liang Wu) ； 薛博仁(Po-Ren Hsueh) ； 金湘玲(Shiang-Ling King) ； 許正園(Jeng-Yuan Hsu)

《胸腔醫學》 20卷5期 (2005/10) Pp. 422-430

https://doi.org/10.29806/TM.200510.0009

摘要

背景：近年來因產生廣效性乙內醯胺酶(extended-spectrum b-lactamase-ESBL)的菌種盛行率有逐漸增加的趨勢，本研究之目的在於看是否可從病人住院前之各項因子或來源來篩選出容易殖生此類菌種之病人。
方法：本研究從2002年10月至2003年4月中間兩階段共5個月的時間收集所有住進台中榮民總醫院呼吸加護病房的患者相關資料，並在住院48小時內採集直腸檢體予以培養，再從病人各項記錄及細菌培養結果去做分析。
結果：從260位患者採集到的腸道檢體中，共有28位帶有產生廣效性乙內醯胺酶的菌種，我們根據病人入院前48小時所在的地點將之分為三組：一般社區來的有93位，地區醫院92位，醫學中心75位。帶有產生廣效性乙內醯胺酶菌種的比率分別為6%，14%，8%。
結論：在呼吸加護病房患者中發現腸道殖生產生廣效性乙內醯胺酶菌種有增多的趨勢，從地區醫院轉介而來的患者為尤。從相關數據發現無法從臨床的特徵來預測何者為可能在腸道殖生產生廣效性乙內醯胺酶菌種的患者，所以對於呼吸加護病房志者剛住院的隔離預防措施以防止院內的傳播是必要的。

關鍵字

產生廣效性乙內醯胺酶菌種 ； 腸道殖生 ； 加護病房 ； 大腸桿菌 ； 克雷白氏菌

並列摘要

Background: The prevalence of extended-spectrum β-lactamase (ESBL)-producing Escherichia coil and Klebsiella pneumoniae has increased markedly in recent years. The aim of this study was to determine the risk factors of colonization by ESBL-producing E. coli or K. pneumoniae and their association with the patient's location prior to admission.
Methods: The study was conducted over a 5-month period in a respiratory intensive care unit. All patients were enrolled with their consent. A rectal swab was done within 48 hours of admission, and a double-disc diffusion test was used to detect the ESBL-producing organisms. The medical records of those patients were reviewed retrospectively.
Results: In all, 260 cases were enrolled. Twenty-eight of the patients revealed ESBL-producing E. coil or K. pneumoniae colonization in the feces. According to their location for 48 hours before admission, we divided the patients into 3 groups: community (n=93), local hospital (n=92), and medical center (n=75). The incidence of fecal colonization of ESBL-producing organisms was 6%, 14%, 8% in each group. However, the clinical features between the ESBL and non-ESBL patients were similar in our series.
Conclusions: Fecal colonization of ESBL-producing organisms was common in patients on admission to the respiratory intensive care unit, especially those from the local hospital. There were no clinical characteristics to predict colonization on admission, so a cohort barrier observation should be considered in the RICU to prevent the nosocomial spread of ESBL-producing E. coil or K. pneumoniae infections.

並列關鍵字

ESBL ； fecal colonization ； ICU ； E. coli ； Klebsiella pneumoniae