- 學位論文
醫院長照單位生物氣膠及其抗生素抗藥性採樣評估
Evaluation of Bioaerosol and Antibiotic Resistance Characteristics in Hospital Long-term Care Unit
摘要
細菌抗生素抗藥性是一個全球關注的議題，而醫院是抗藥性細菌問題中最重要的一環，本研究針對中部某醫院長期照護單位進行生物氣膠暴露評估，以瞭解工作環境中抗藥性細菌的分佈情形及員工暴露狀況，選定醫院中加護病房（intensive care unit, ICU）、呼吸照護病房（respiratory care ward, RCW）、護理之家（nursing home）三種不同的照護環境，經由臨床資料收集分析、空氣採樣、工作人員鼻腔採樣等，完成抗藥性細菌調查的初步研究，期間自2013年7月至2013年9月進行環境採樣，利用安德森六階、AGI-30及Biosampler生物氣膠採樣器，搭配TSA培養皿進行採樣，並隨機採集醫療照護人員（health care workers, HCWs）鼻腔細菌進行培養，進一步以全自動微生物鑑定和藥敏性試驗分析儀（Phoenix），鑑定醫院生物氣膠菌種及其抗藥性評估。 結果顯示，在所採集之空氣致病菌中，長期照護單位（RCW, nursing home）在細菌抗藥性比例及分佈上無明顯差異，但與短期照護單位（ICU）有較明顯差異。空氣中細菌具抗藥性基因（mecA）之比例，呼吸治療病房及護理之家（長照單位）高於加護病房，且護理之家工作人員鼻腔細菌具 mecA基因比例也高達40 %，在人口密集機構中，此種現象對細菌間彼此傳遞抗藥性基因有潛在的風險 ，同時對員工及住民都是一種危害。此研究結果顯示，工作人員鼻腔帶菌（金黃色葡萄球菌）之比率及生物氣膠抗藥性比例—長期照護單位（RCW, nursing home）皆高於短期照護單位（ICU），此結果或許可解釋—為何長照單位住民有經常性、反覆性感染的現象，且也顯示細菌將更容易有彼此傳遞抗藥性基因的機會，以上兩種現象將造成惡性循環。因此，應更關注於長期照護機構住民的感染控制問題，常規地監測危險因子（通風換氣次數、環境抗藥性細菌採樣），並建立更明確適用於長照單位的感染控制策略。
並列摘要
Strains that exhibit antibiotic resistance are a global public health concern, especially in hospitals. Drug-resistant strains carried by inpatients are likely to be spread through skin contact, respiration and/or body fluids in crowded public health service centers. Growing numbers of reports have showed that Coagulase-negative Staphylococcus（CoNS）strains have a high rate of antibiotic resistance and thus research on the spread of antibiotic-resistant CoNS in the hospital is becoming increasingly important. This study focused on the sampling of antibiotic-resistant bacteria （ARB）in hospital long-term care wards in central Taiwan. Strain samples were collected from three separate locations: a medical intensive care unit （ICU）, respiratory care ward（RCW）and a nursing home nearby RCW. Meanwhile, the nasal swab samples from health care workers （HCWs） were collected, cultured and compared with the air samples. The study, for which sampling was repeated three times from three locations, was carried out from July 2013 to September 2013. Nasal swabs were taken from 90 randomly selected HCWs. A six-stage Andersen with Tryptic Soy Agar （TSA） substrate, AGI-30 and Biosampler with buffer solution were used to collect bioaerosols. The samples were then cultured and incubated aerobically at 35 ℃ for 48 hours. The cultured colonies were identified based on morphology, gram stain and full-automatic micro-organism identification, using a Phoenix analyzer. Although most samples had resistance to some of the 21 antibiotics also used for analysis in this project, the data showed a higher proportion of antibiotic-resistant strains in nursing home and RCW compared with those from ICU. Moreover, the study revealed that mecA gene of nasal carriage of airborne S. aureus strains was about 40 % of the health care workers, and multiple resistant staphylococcus from air were found more commonly in RCW and nursing home than ICU. The results could also explain why residents from long-term care facilities experience recurrent infection and an accelerated spread of antibiotic-resistant strains. More attention should be paid to the inspection and control of antibiotic resistant strains in long term care units.
參考文獻
延伸閱讀
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