- 期刊
北部某醫學中心內科加護單位萬古黴素抗藥性腸球菌院內血流感染疑似群突發調查
Outbreak Investigation of Vancomycin-resistant Enterococcus faecium Healthcare-associated Bloodstream Infection in a Medical Intensive Care Unit at a Medical Center in Northern Taiwan
摘要
腸球菌（Enterococcus spp.）是引起醫療照護相關感染（healthcare-associated infection, HAI）的常見細菌之一，而台灣近幾年由vancomycin-resistant Enterococcus（VRE）引起的HAI，似乎有增加的趨勢。北台灣一教學醫院進行例行性HAI資料分析時發現，某內科加護單位E. faecium相關的血流感染（bloodstream infection, BSI）在2010年有明顯的增加，且14例個案中有13例是VR E. faecium（VREf）。臨床資料顯示，此13株VREf來自9個不同床位的11位病人，分別發生在十個不同月份，每月最多3例。脈衝式電泳分析結果顯示，此13株VREf分屬於10種基因型，只有於三、 四月份出現的4株VREf同屬於B型或它的亞型。以BioNumerics軟體套組進一步分析，這些菌株大致可分成二群，其中一群共有7株，全部出現在六月之後。另外一群有6株，除了一株外，其他均出現在四月以前。此外，有一位病人分別在3個不同月份各被培養到一株VREf，但基因型完全不同。調查結果顯示，雖然三、 四月間似乎有一個由B型菌株造成的小型群突發，但因五月完全無個案，所以當時並未被深入調查，而其他月份則無特定基因型菌株於病人間交叉傳染的情形。本次調查雖未能確認感染個案數明顯增加的原因，但因感控人員的介入，後續個案明顯減少，該單位於2011年全年僅出現3例VREf。本研究結果顯示，分析HAI資料時，除了檢視當月份個案數的變化外，若能同時檢視累積的數據，比較能在個案數增加的初期及早發現，藉由早期的調查，可望避免後續更嚴重問題的出現。
並列摘要
Enterococcus is frequently associated with healthcare-associated infection (HAI), and vancomycin-resistant enterococcal infection is increasing in Taiwan. During the retrospective analysis of HAI records in 2010, a significant increase of vancomycin-resistant E. faecium (VREf) bloodstream infection (BSI) was identified in an intensive care unit (ICU) at a medical center in northern Taiwan. Thirteen of the 14 E. faecium infection were caused by VREf. The 13 VREf were isolated from 11 patients in 9 beds. They were distributed among 10 months with less than 3 cases per month. All isolates were of different pulsotypes except that 4 isolates identified in March and April were grouped into one pulsotype B or its subtype. Analysis by a BioNumerics software identified two separate groups of VREf cases. One consisted of 7 isolates that were all recovered after June. The other contained 6 isolates identified before April with one exception found in July. One patient was found to have 3 episodes of VREf BSIs that occurred in 3 different months and with different pulsotypes. Although there was a small cluster of infection cases caused by a pulsotype-B clone in March and April, no investigations were subsequently conducted due to the fact that no additional cases were found in May. There was also no evidence of a predominant clone of VREf that was circulating among the patients. Although the major problem associated with the sudden increase of the VREf BSIs was not identified, interventions by infection control personnel had led to the significant decrease of the subsequent infection cases. Only 3 such cases were identified in the ICU in 2011. Monitor of HAI records should not only analyze the change of the case numbers among each month, but the accumulated results should also be examined. In this way, the increase of infection cases may be possibly discovered in the early stage, the effective surveillance may then be executed, and the problem be well controlled before it becomes more deteriorated.
延伸閱讀
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