南台灣某教學醫院多重抗藥性菌株的相關因子分析

Risk Factors for Multiple Drug-Resistant Organisms in Intensive and Respiratory Care Units of a Teaching Hospital in Southern Taiwan

陳怡蘋(Yi-Ping Chen) ； 蔡曉雯(Hsiao-Wen Tsai) ； 董雅玲(Ya-Ling Tung) ； 朱蓓蓓(Pei-Pei Chu) ； 張簡淑贈(Shu-Tseng Chang Chien) ； 盧柏樑(Po-Liang Lu) ； 張科(Ko Chang)

《感染控制雜誌》 31卷3期 (2021/06) Pp. 109-122

https://doi.org/10.6526/ICJ.202106_31(3).0001

摘要

多重抗藥性菌株（multiple drug resistant organisms, MDROs）威脅人類健康增加治療難度。本研究目的為調查南部某區域教學醫院特殊病房MDROs的相關因子。採回溯性研究在該院確診為MDROs感染者，期間自2015年6月至2019年8月，對照組為同時段同病房未感染MDROs住院病人，計110名病例組和110名對照組病人。MDROs包括vancomycin-resistant enterococcus（VRE）、methicillin-resistant Staphylococcus aureus（MRSA）、carbapenemresistant Klebsiella pneumoniae（CRKP）、carbapenem-resistant Escherichia coli（CREC）、carbapenem-resistant Acinetobacter baumannii（CRAB）、carbapenem-resistant Pseudomonas aeruginosa（CRPA）。特殊病房共檢驗出MDROs 110株，MRSA有43株、VRE 11株、CRAB28株、CRPA 21株、CR-KP與CR-EC共7株，其中VRE, CRAB, CRPA，有逐年上升趨勢；而MRSA趨勢為下降。經單變項相關因子分析，發現年齡、抗Pseudomonas aeruginosa藥物、抗MRSA藥物和使用呼吸器為MDROs感染相關因子，再進行羅吉斯回歸分析，結果為使用抗Pseudomonas aeruginosa類藥物感染到MDROs相關風險勝算比為未使用此類藥感染者的2.6倍（95% CI = 1.4~5, p = 0.003）；使用抗MRSA類藥物相關風險勝算比6.3倍（95% CI = 2.7~14.9, p ＜ 0.001），共同使用此2類藥物的病人其得到MDROs的相關風險為未使用這兩類管制藥病人相關風險勝算比11.5（95% CI = 3.9~40.8, p = 0.023）。因本研究為單一區域醫院、MDROs菌株數量和年份之條件有限，故無法推論至其他醫院，但依本研究之發現仍指出MDROs感染和使用抗Pseudomonas aeruginosa類與抗MRSA類藥物有顯著相關。MRSA於社區中已普遍存在，此次研究中也發現在MDROs中MRSA佔比最多，若日後有相關研究建議進行基因分型，以釐清其可能傳染源。

關鍵字

多重抗藥性菌株 ； 抗生素 ； 住院日數 ； 侵入性導管

並列摘要

Multiple drug-resistant organisms (MDROs) threaten human health and increase the difficulty of clinical treatment. The purpose of this study was to investigate the correlation factors of MDROs in the intensive care unit of a teaching hospital in southern Taiwan. A retrospective study was conducted from June 2015 to August 2019, and patients diagnosed with MDRO infection were enrolled. The control group included hospitalized patients who were not simultaneously infected with MDROs in the same ward. There were 110 cases in the control group. MDROs include vancomycin-resistant Enterococcus (VRE), methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Klebsiella pneumoniae (CR-KP), carbapenem-resistant Escherichia coli (CR-EC), carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Pseudomonas aeruginosa (CRPA). A total of 110 strains of MDROs were tested in the intensive care unit, including 43 strains of MRSA, 11 strains of VRE, 28 strains of CRAB, 21 strains of CRPA, and seven strains of CR-KP and CR-EC. Among them, VRE, CRAB, and CRPA showed an upward trend every year, whereas MRSA showed a downward trend. The univariate analysis revealed age, anti-Pseudomonas aeruginosa and anti-MRSA drugs, and respirators to correlate with MDRO infection. The logistic regression analysis showed that the use of anti-Pseudomonas aeruginosa drugs for MDROs was 2.6 the odds ratio of those infected without such drugs (95% confidence interval [CI] = 1.4~5, p = 0.003); the odds of using anti- MRSA drug-related risk odds ratio was 6.3 (95% CI = 2.7~14.9, p ＜ 0.0001), and the relative risk of MDROs for patients who used these two types of drugs together was 11.5 (95% CI = 3.9~40.8, p = 0.023) compared to patients who did not use these two types of controlled drugs. Because the study was conducted in a single regional hospital, the number of MDRO strains and conditions of the year were limited. Whether or not this result can be applied to other hospitals remains unclear. However, the findings of this study indicated that correlation factors of MDROs were significantly related to the use of anti-Pseudomonas aeruginosa and anti-MRSA drugs. MRSA was ubiquitous in the community, and this study revealed that it accounted for the largest proportion of MDROs. In future related studies, genotyping should be performed to clarify the possible source of infection.

並列關鍵字

multiple drug resistant organisms ； antibiotic ； length of days ； invasive catheter