碳青黴烯抗藥性克雷伯氏肺炎桿菌(CRKP)與醫療 照護相關感染趨勢及危險因子之相關性研究

Trends and Risk Factors of Carbapenem-resistant Klebsiella pneumoniae and Health-care Associated Infection

黃宜玟(YI-WEN HUANG)

指導教授 ： 林冠語

中臺科技大學/護理學院/護理研究所/碩士(2019年)

摘要

碳青黴烯(carbapenem)類抗生素為廣效性β-lactam類藥物，常被用來治療多重抗藥性細菌的感染，而近年來革蘭氏陰性菌，對carbapenem類抗生素產生抗藥性(carbapenem-resistant Enterobacteriaceae, CRE)情形日益增加，特別是克雷伯氏肺炎桿菌(Klebsiella pneumoniae, KP)使得臨床治療上產生極大的挑戰與困難，2015-2017年中部某醫學中心CRE抗藥性占比由8.2%上升至12.3%，其中尤以碳青黴烯抗藥性克雷伯氏肺炎桿菌(carbapenem-resistant Klebsiella pneumoniae, CRKP)為最多，因此進行CRKP及醫療照護相關感染之流行趨勢及分析CR-KP與醫療照護相關感染之相關危險因子。
本研究採病歷回溯性研究，分析中部某醫學中心於2015年1月至2017年12月醫療照護相關感染資料，並將收案菌種為KP者，再區分為CRKP（研究組）及non-CRKP（對照組）等二類別，收集臨床數據以列出CRKP感染可能之風險分子，以皮爾森卡方檢定(Pearson's chi-squared test)或連續性校正(Fisher精確檢驗)、t檢定等統計方式進行比較，並在單變項與多變項羅吉斯迴歸模型下進行分析，類別變項並計算勝算比(Odds ratios)與95%信賴區間(95% confidence intervals, 95% CI)分析。
多變項羅吉斯分析結果顯示，在心血管疾病(OR= 3.33; 95% CI: 1.24- 8.97; p= 0.017)、carbapenem暴露(OR= 3.70; 95% CI: 1.69-8.10; p= 0.001)、導尿管留置(OR=3.51; 95% CI: 1.30- 9.50; p= 0.013)及血液透析導管置放(OR= 6.57; 95% CI: 2.17- 19.91; p= 0.001)共4項危險因子均達統計上的顯著差異，皆為CRKP感染之獨立危險因子。
近年來CRKP導致醫療照護相關感染的比例逐年增加，在臨床上建議針對心血管疾病、carbapenem暴露、放置有血液透析導管及導尿管留置的病人，應減少非必要的侵入性醫療裝置之使用。此外，確實執行環境清消、落實手部衛生、遵照導管組合式照護及合理抗生素之使用原則，以降低醫療照護相關感染及CRKP感染之風險。

關鍵字

碳青黴烯抗藥性克雷伯氏肺炎桿菌 ； 醫療照護相關感染

並列摘要

Carbapenems are broad spectrum β-lactam antibiotic agents commonly used for the treatment of multidrug-resistant bacterial infections. In recent years increasing trend of CRE- carbapenem-resistant Enterobacteriaceae, a family of Gram-negative bacillus shown, particularly carbapenem -resistant Klebsiella pneumoniae (CRKP), resulting in huge challenges and difficulties to treatment. During the period of 2015 to 2017, the CRE proportion at a medical center in central Taiwan rose from 8.2% to 12.3%, and CRKP was the highest. Therefore we started an investigation and analyzed the trend of CRKP healthcare -associated infections (HAIs) and analyze the risk factors for CRKP and HAIs.
We conducted a retrospective case‑control study by analyzing HAIs information of a medical center in central Taiwan from January, 2015 to December, 2017. We divided KP infection cases into 2 groups: CRKP (case group) and non-CRKP (control group). Clinical data were collected to identify risk factors for CRKP infection. The risk factors was compared using Pearson's Chi‑square test or continuity correction (Fisher’ exact), the t‑test, and were analyzed under univariable and multivariable logistic regression model. We also calculate the odds ratios (ORs) and the 95% confidence intervals (CIs) for the dichotomous categorical variables. Two- tailed p < 0.05 was considered statistically significant.
Multivariate logistic regression analysis showed 4 statistically significantly risk factors, including cardiovascular disease (OR= 3.33; 95% CI: 1.24- 8.97; p= 0.017); exposure to carbapenem (OR= 3.70; 95% CI: 1.69-8.10; p= 0.001); indwelling urinary catheter (OR=3.51; 95% CI: 1.30- 9.50; p= 0.013), and indwelling hemodialysis catheter (OR= 6.57; 95% CI: 2.17- 19.91; p= 0.001) were all independent risk factors for CRKP infections.
In recent years, HAIs caused by CRKP was increasing year by year. In clinical practice we suggest the patients with cardiovascular disease, exposure to carbapenem, indwelling urinary catheter and indwelling hemodialysis catheters should avoid the using of unnecessary invasive treatment. Besides, implementation of environmental cleaning and disinfection, hand hygiene, close compliance with infection control bundles, and prudent administration of antibiotics are recommended for minimizing the risk of HAIs and acquisition of CRKP infection.

並列關鍵字

Carbapenem-resistant Klebsiella pneumoniae ； Health-care Associated Infection

參考文獻

中文文獻

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