某醫學中心人類免疫缺乏病毒感染病人之醫療照護相關感染

Analysis of Healthcare-Associated Infections among Human Immunodeficiency Virus-Infected Patients Admitted in a Medical Center

洪靜如(Ching-Ju Hung) ； 陳瑛瑛(Fu-Der Wang) ； 王永衛(Yin-Yin Chen) ； 王復德(Wing-Wai Wong)

《感染控制雜誌》 28卷2期 (2018/04) Pp. 49-61

https://doi.org/10.6526/ICJ.201804_28(2).0001

摘要

人類免疫缺乏病毒(human immunodeficiency virus, HIV)感染者由於免疫功能不全，發生醫療照護相關感染風險相對增加。本研究採回溯性研究，分析某醫學中心2005~2013年間人類免疫缺乏病毒感染病人發生醫療照護相關感染分布，結果：HIV病人入院共1,130人次，發生41人次醫療照護相關感染，感染率為3.63%；感染人次有逐年增加，但感染率無顯著上升趨勢(p = 0.620，χ2 for trend)。感染個案以男性居多佔85.4%，感染時病程已進展至AIDS (acquired immunodeficiency syndrome)者佔92.7%，入院時出現伺機性感染者佔73.2%，住院期間CD4+T細胞值小於200 cell/mm^3佔76.9%，感染前7天曾發生休克(血壓 ＜ 90 mmHg)佔7.3%；常見感染部位前3名依序為血流感染(41.5%)、泌尿道感染(39%)、呼吸道感染(12.2%)；感染菌種前3名分別為Acinetobacter baumannii (17.4%)、Escherichia coli (17.4%)、Staphylococcus aureus (13%)。進一步分析感染後30天內死亡預後之危險因子，單變項分析結果顯示具統計學上顯著差異之變項為休克及感染後住院天數(p ＜ 0.05)；多變項分析控制年齡、性別、感染後住院天數、伺機性感染、休克、CD4+T細胞值、惡性淋巴瘤及加護病房等所有變項後均不具統計學上顯著差異(p ＞ 0.05)。結論：血流感染為HIV病人最常發生之感染部位；A. baumannii及E. coli為最常見之感染菌種。

關鍵字

人類免疫缺乏病毒感染 ； 醫療照護相關感染

並列摘要

Human immunodeficiency virus (HIV)-infected patients are at higher risk of developing healthcare-associated infections (HAIs) because of their weakened immune system. However, data on the occurrence of HAIs in HIV-infected patients are limited. This study aimed to analyze the incidence and epidemiology of HAIs in this population. A retrospective study was conducted on all HIV-infected patients admitted to a medical center in Taiwan from 2005 to 2013. A univariate analysis was performed using a chi-square or Fisher’s exact test. A multiple analysis was performed using logistic regression model to assess the potential risk factors and prognostic indicators of HAIs. During the study period, about 1,130 HIV-infected patients were admitted, and 41 episodes of HAI (3.6% per admission) were identified in 30 patients. The incidence of HAI slightly increased every year (p = 0.620; chi square test for trend). The proportional frequencies of HAIs were as follows: 17 bloodstream infections, 41.5%; 16 urinary tract infections, 39%; 5 respiratory tract infections, 12.2%; 1 skin infection, 2.4%; 1 gastrointestinal tract infection, 2.4%; and 1 venous infection, 2.4%. The most common pathogens were Acinetobacter baumannii (17.4%), Escherichia coli (17.4%), and Staphylococcus aureus (13%). The mortality rate of HAI was 46.7%. Shock (BP ＜ 90 mmHg) and the length of postinfection stay were significantly associated with death (p ＜ 0.05). Bloodstream infections were the most frequent infection by site. HAIs were associated with a high mortality rate. A. baumannii and E. coli were the leading pathogens responsible for HAIs. Shock and the length of postinfection stay were related risk factors of mortality.

並列關鍵字

Human immunodeficiency virus infections ； healthcare-associated infections