Multi-Drug Resistant Acinetobacter Baumannii (MDRAB) Infection: Experience from a Burn Center

多重抗藥性鮑氏不動桿菌感染：林口長庚醫院燒燙傷中心的治療經驗

陳宏彰(Hung-Chang Chen) ； 楊瑞永(Jui-Yung Yang) ； 莊秀樹(Shiow-Shuh Chuang) ； 楊士毅(Shih-Yi Yang)

《臺灣整形外科醫學會雜誌》 21卷2期 (2012/06) Pp. 107-115

https://doi.org/10.7096/TJTSPS.201206.0107

摘要

背景：住院病患，特別是加護病房病患的多重抗藥性鮑氏不動桿菌（Multi-drug Resistant Acinetobacter Baubannii，以下簡稱MDRAB菌）感染，在最近幾年引起很大的重視。林口長庚醫院燒燙傷中心也面臨同樣的問題。因此，面對這隻病源菌，找出預防，感染控制與治療的方法是減少併發症，死亡率，與住院日數最好的方法。目的及目標：我們審查了林口長庚燒燙傷中心自2001年至2009年鮑氏不動桿菌（Acinetobacter Baubannii，以下簡稱AB菌）與MDRAB菌的院內感染發生率，並試圖從過去的經驗與文獻上的資料來找出控制MDRAB菌院內感染的方法。材料及方法：我們蒐集了所有林口長庚燒燙傷中心自2001年至2009年遭受AB菌與MDRAB菌院內感染的病患，這些病患的資料被統計與分析。結果：林口長庚燒燙傷中心自2001年至2009年有十七個病患，包括12位男性與5位女性，總共發生20次MDRAB菌院內感染。MDRAB菌院內感染發生率是0.27（次數／1000病患住院日）。最常見的MDRAB菌院內感染是血循感染（55%）。病患的平均年齡是49.8+/-25.7歲（2-85歲）。這些病患在燒燙傷中心住院後平均19.1+/-14.9天（4-56天）經細菌培養確認是MDRAB菌院內感染。這17位病患有9位是火焰灼傷（53%），5位是燙傷（29%），1位是化學性灼傷（6%）。平均燒燙傷面積是39.3+/-30.7%（3-100%）；平均住院日數是53.5+/-32.2天（21-154天）。有5位病患（29%）死亡，其中兩位死於MDRAB菌血循感染，兩位死於MDRAB菌傷口感染，1位死於MDRAB菌呼吸道感染。結論：MDRAB菌院內感染會持續在世界，台灣，與林口長庚燒燙傷中心發生，雖然發生率不高，但感染的風險永遠存在。經由我們過去的經驗與文獻資料顯示MDRAB菌院內感染可能會增加併發症，死亡率，住院日數與社會經濟的損失。適當的抗生素治療，感染控制，抗生素使用管理可以控制並減少MDRAB菌院內感染的發生率。

並列摘要

Background: Multi-drug Resistant Acinetobacter Baubannii (MDRAB) has been bring the great concern for infection control in hospitalized patients, particularly those in intensive-care units (ICUs) such as burn unit in recent years. Prevent and control the infection from this organism can reduce the morbidity, mortality and length of hospital stay. Aim and Objective:We reviewed the incidence of the Acinetobacter Baubannii (AB) nosocomial infections (NIs) and among those the MDRAB NIs in Linkou Burn Center (LBC). We also reviewed our experience and internet literatures and try to find the way to control MDRAB NIs. Materials and methods:From 2001 to 2009, incidence of the Acinetobacter Baubannii (AB) nosocomial infections (NIs) and among those the MDRAB NIs in Linkou Burn Center (LBC) were evaluated. The demographic data of affected patients was also collected. Results:Seventeen patients including 12 males and 5 females developed 20 MDRAB NIs in LBC during 2001-2009. The incidence of MDRAB NIs is 0.27 NIs / 1000 patient days. The most common MDRAB NIs in LBC was blood stream infection (BSI) (55%). The mean age of these 17 patients was 49.8 +/- 25.7 years old (range, 2-85). The mean interval of MDRAB NIs confirmed by culture after ICU admission was 19.1 +/- 14.9 days (range, 4-56). Causes of burn injury were 9 flame burns (53%), 5 scald burns (29%), and one chemical burn (6%). Mean TBSA was 39.3 +/- 30.7% (range, 3-100%). The mean length of hospital stay was 53.5 +/- 32.2 days (range, 21-154). Five (29%) patient expired, including 2 BSI, 2 BWI and one LRI.Conclusions:MDRAB will persist and sporadic emerges in world, Taiwan, CGMH and LBC. The incidence is not high but the risks always exist. MDRAB may increase the morbidity, mortality, hospital stay and socioeconomic loss in burn unit. Proper antibiotic treatment, infection control, antibiotics stewardship and prevention measures can control or decrease the incidence.

並列關鍵字

Multi-drug Resistant Acinetobacter Baumannii (MDRAB) ； infection control