長期照護機構的院內感染－以某護理之家爲例

Nosocomial Infection in One Long Term Care Facility-A Nursing Home

李聰明(Chun-Ming Lee) ； 陳雅玲(Ya-Ling Chen) ； 楊嘉玲(Chia-Ling Yang)

《內科學誌》 19卷4期 (2008/08) Pp. 331-336

https://doi.org/10.6314/JIMT.2008.19(4).07

摘要

近代醫藥與公共衛生的進步，國人壽命普遍延長，人口老化的趨勢愈來愈明顯，使得長期照護機構的需求日益增加。由於長期照護機構內住民的特殊性，機構內的院內感染也是不可避免的。國外早有長期照護機構院內感染流行病學的相關研究，反觀國內的相關資料較爲缺乏。本篇爲前瞻性的研究，對象爲所有入住某護理之家之住民；研究期間自2003年10月l日至2005年9月30日止，爲期共2年。研究的內容包括機構內院內感染發生密度、各部位感染率、相關細菌學的調查及各部位感染菌種之分布。結果顯示入住總人日數54,468，有98位住民發生224人次機構內院內感染，感染發生密度爲4.11‰，感染住民平均年齡79.6歲。感染部位中，以泌尿道感染最爲常見，有94人次(42%)；其次爲呼吸道感染84人次(37.5%)；及血流感染30人次(13.4%)。機構內院內感染事件中有127人次感染不僅有臨床症狀並經實驗室確認，總共分離出175隻菌株，其中以革蘭氏陰性菌123株(70.3%)居多，其次爲革蘭氏陽性菌46株(26.3%)及病毒6株(3.4%)。菌種排名第一的是大腸桿菌(Escherichia coli)34株(19.4%)，其次爲綠膿桿菌(Pseudomonas aeruginosa)28株(16%)，變形桿菌(Proteus mirabilis)21株(12.0%)及金黃色葡萄球菌(Staphylococcus aureus)16株(9.1%)。值得注意的事，該長期照護機構所培養出來的多重抗藥性菌種並不少見，其中具有廣效性乙醯胺酶(extended spectrum beta lactamase)大腸桿菌爲35.3%(12/34)，廣效性乙醯胺酶克雷白氏菌(Klebsiella pneumoniae)36.4%(4/11)，而所有的金黃色葡萄球菌均爲抗苯青黴素金黃色葡萄球菌(Methicillin resistant Staphylococcus aureus, MRSA)。引起多重抗藥性菌種的原因有待進一步的探討。

關鍵字

長期照護機構 ； 院內感染 ； 感染發生密度 ； 廣效性乙醯胺酶 ； 多重抗藥

並列摘要

Life spans of elderly people are increasing due to medical advances. Increased population of elderly people leads to more need of long term care facilities. Because there were special situations in residents of long term care facilities, nosocomial infections are not uncommon. Many studies about long term care facilities were present in foreign countries but there were only few studies in our country from the literature review. This is a prospective study that we analyzed the infection density, sites, sources and organisms of nosocomial infection in one long term care facilities- a nursing home. From October 1, 2003 to September 30, 2005, 2-year duration, there were total 54,468 patient-hospitalization days and the nosocomial infection density was 4.110/00. The total 224 patientepisodes nosocomial infections were reported in 98 patients, and mean age was 79.6 year. Urinary tract infection was the most frequent 42% (94/224), followed by respiratory tract infection 37.5% (84/224) and blood stream infection 13.4% (30/224). A total of 175 strains of microorganisms were isolated, 70.3% (123/175) were Gramnegative organisms and 26.3% (46/175) were Grampositive organisms and 3.4% (6/175) was viral infection. Among these, Escherichia coli were 19.4% (34/175) and Pseudomonas aeruginosa in 16% (28/175), Proteus mirabilis in 12% (21/175) and staphylococcus aureus in 9.1% (16/175), respectively. Multiple drugs resistant pathogens were not infrequently seen in this long term care facilities and extended spectrum beta lactamase Escherichia coli was 35.3% (12/34), extended spectrum beta lactamase Klebsiella pneumoniae was 36.4% (4/11) and all the Staphylococcus aureus belong to Methicillin resistant Staphylococcus aureus (16/16). Further study needed to find the cause of multiple drugs resistant organisms in this long term care facilities.

並列關鍵字

Long term care facility ； Nosocomial infection ； Infection density ； Extended spectrum beta lactamase, ESBL ； Multiple drugs resistant