探討急診入住外科加護病房患者抗Methicillin金黃色葡萄球菌帶菌盛行率與其移生相關因素

Prevalence and Risk Factors of MRSA Colonization of Patients in Surgical Intensive Care Unit

楊惠茹(HUI-JU YANG)

指導教授 ： 戴金英

中臺科技大學/護理學院/護理研究所/碩士(2018年)

摘要

背景：抗Methicillin金黃色葡萄球菌（methicillin-resistant Staphylococcus aureus, MRSA）之盛行率依地區性與國家不同而有差異，臺灣院內感染監視系統之資料顯示，醫學中心及區域醫院加護病房（Intensive Care Unit, ICU）中的抗藥性菌株屬於MRSA之感染密度曾高達4.7‰-6.0‰，而MRSA常併發敗血症、心內膜炎、肺炎及皮膚軟組織感染等病症，而延長個案的住院日數、增加醫療費用與死亡率。主動鼻腔篩檢可早期發現移生患者，早期執行接觸隔離，以預防後續MRSA的感染發生。因此，本研究目的是探討急診入住外科加護病房患者在48小時內MRSA鼻腔移生率與其相關因素。
研究方法：採用次級資料分析法，所使用的資料庫為橫斷性研究設計，於某區域教學醫院成人的外科加護病房收集資料，針對急診入住病人48小時內主動監測培養（Active Surveillance Culture, ASC）MRSA鼻腔篩檢，經取得檢體進行MRSA菌株培養。並藉由病歷回溯的方式收集個案有關MRSA鼻腔移生之相關因素。所得資料以描述性統計、卡方檢定、多元邏輯斯迴歸分析等檢定之。
研究結果：研究顯示加護病房48小時內MRSA鼻腔移生率為10.5%，單變量分析顯示入院前住所、疾病嚴重度分數（Acute Physiology and Chronic Health Evaluation Ⅱ, APACHE Ⅱ）、動脈血液氣體分析pH值異常、血球容積比異常、血液中白血球計數過高等變項，與MRSA鼻腔移生有顯著相關性。在多變量分析，只有動脈血液氣體分析pH值異常與血球容積比異常二個變項，與MRSA鼻腔移生有顯著相關性。
討論與結論：本研究調查結果顯示加護病房患者，其入院前住所、APACHE Ⅱ分數、動脈血液氣體分析pH值、血球容積比和血液中白血球計數等變項，為ASC之MRSA鼻腔移生的相關因素，醫護人員應積極評估入住ICU患者是否為MRSA鼻腔移生之高危險群，並對MRSA鼻腔移生之高危險群患者應提早執行接觸隔離措施，以期降低MRSA移生造成後續感染。

關鍵字

外科加護病房 ； 抗Methicillin金黃色葡萄球菌 ； 移生 ； 醫療照護相關感染

並列摘要

Background: The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) varies for different regions and countries. Data from Taiwan's nosocomial infection surveillance system indicate that the density of MRSA infection for drug-resistant strains in the intensive care units (ICU) of medical centers and regional hospitals was once as high as 4.7‰-6.0‰. MRSA often has such complications as sepsis, endocarditis, pneumonia and skin and soft tissue infections, which prolong hospitalization days and increase medical costs and mortality. Active nasal screening can detected patients with early colonization so that the early contact isolation of patients can be implemented to prevent subsequent MRSA infection. Therefore, the purpose of this study is to investigate the MRSA nasal colonization rate and its related factors within 48 hours of emergency patients being admitted to the surgical intensive care unit.
Methods: Secondary data analysis was used. The database used was designed for cross-sectional studies. Data were collected from adult surgical intensive care units in a regional teaching hospital. MRSA nasal screening was performed by Active Surveillance Culture (ASC) to emergency patients within 48 hours of admission, and MRSA strain was cultured after the specimen was obtained. The relevant factors related to MRSA nasal colonization of individual cases were collected by means of tracking medical records. The data obtained were verified by descriptive statistics, chi-square test, multivariate logistic regression analysis and etc.
Results: The study showed that the MRSA nasal colonization rate was 10.5% within 48 hours of the intensive care unit. Univariate analysis showed that the pre-hospital residence, Acute Physiology and Chronic Health Evaluation II (APACHE II), abnormal pH value in the arterial blood gas analysis, abnormal hematocrit ratio, excessively high count of white blood cells in the blood and other variables had a significant correlation with MRSA nasal colonization. In multivariate analysis, only two variables, namely, abnormal pH value in the arterial blood gas analysis and abnormal hematocrit ratio were significantly correlated with MRSA nasal colonization.
Discussion and Conclusions: The results of this study show that for the patients in the Intensive Care Unit, their pre-hospital residences, APACHE II scores, arterial blood gas analysis pH values, hematocrit ratios, and blood white blood cell counts are the risk factors for ASC MRSA nasal colonization. The medical staff should actively assess whether ICU patients in a high risk group for MRSA nasal colonization, and perform early contact isolation measures for patients in the high risk group of MRSA nasal colonization so as to reduce infection caused by MRSA colonization.

並列關鍵字

Surgical intensive care unit ； methicillin-resistant Staphylococcus aureus ； colonization ； Healthcare associated infection

參考文獻

中文文獻

王志堅、朱夢麟（1990）．Methicillin抗藥性金黃色葡萄球菌之抗藥機轉．Journal of Medical Sciences，10（6），341-348。

江欣怡、王梨容、柯文謙、林裕森、柯乃熒（2011）．加護病房環境Methicillin抗藥性金黃色葡萄球菌污染與病人移生之關係．感染控制雜誌，21（1），1-11。

林佳蓉、陳瑛瑛（2010）．抗藥性金黃色葡萄球菌與防治策略．護理雜誌，57（3），93-98。doi:10.6224/jn.57.3.93

張上淳（1993）．MRSA院內感染之防治措施．院內感染控制通訊，3（4），12-16。