護理之家住民因泌尿道感染而住院之調查研究

Hospitalized Urinary Tract Infections in Residents of a Nursing Home

陳鼎達(Ting-Tat Chan) ； 黃麗卿(Lee-Ching Hwang) ； 鍾嫈嫈(Jin-Jin Tjung) ； 張家銘(Chia-Ming Chang)

《台灣老年醫學雜誌》 1卷2期 (2005/11) Pp. 65-78

https://doi.org/10.29462/TGG.200511.0003

摘要

目的：泌尿道感染是長期照護機構住民最常發生的感染症之一，但國內未曾出現相關的流行病學數據報告。本研究為探討長期照護機構住民在居住護理之家期間，症狀性泌尿道感染的發生率、危險因子、感染菌種及其抗藥性的情況，以了解其嚴重程度，並建立本土長照住民相關的流行病學資料。
方法：本研究對象為北部一醫學中心附設之護理之家，共有102床。回顧2002年1月至2004年6月期間的住民病歷紀錄，資料收集包括：年齡、性別、主要慢性疾病、功能狀態、排尿方式、入住總天數、因症狀性泌尿道感染住院時主要症狀、尿液培養中的菌種及其抗藥性報告等。
結果：回顧這二年半期間的住民病歷紀錄發現，因症狀性泌尿道感染而住院之發生率為每千人日1.82次。邏輯複迴歸分析發現，有腎臟及泌尿系統診斷者，是症狀性泌尿道感染住院之危險因子。另一方面，五種最常見尿液分離菌種依序為：Escherichia coli、Pseudomonas aeruginosa、Proteus mirabilis、Klebsiella pneumoniae及Enterococcus spp.。產生廣譜乙醯胺酶(extended-spectrum beta-lactamase)的E.coli及K.pneumoniae分別達33.3%及46.7%。Acinetobacter baumannii的比例有4.9%，且普遍對大部分抗生素產生抗藥性，同時也發現泛抗藥性不動桿菌株(pandrug-resistant A. baumannii)。這些抗生素感受性結果與機構所在醫院整體數據相近或更為嚴重。
結論：本研究發現護理之家住民症狀性泌尿道感染的發生率並不低，致病菌種的抗藥性也幾近院內感染菌種。今後迫切需要更多對本土長期照護機構內泌尿道感染的研究，包括前瞻性流行病學研究、感染控制、預防、診斷、抗生素使用時機和方法、及非抗生素治療等，以阻止目前高發生率及高抗藥性等問題的惡化。

關鍵字

症狀性泌尿道感染 ； 護理之家 ； 院內感染 ； 抗藥性

並列摘要

Objectives: Urinary tract infection is one of the most common infections among long-term care residents. In Taiwan, no epidemiology study was conducted on this issue. This study is to explore the incidence of symptomatic urinary tract infections, their risk factors, common responsible pathogens and their antibiotics resistance among residents of a nursing home in Taiwan, so as to establishing local epidemiologic data.
Methods: We conducted a retrospective chart review of residents in a medical center-affiliated nursing home (102 beds) in northern Taiwan from January, 2002 to June, 2004. The following data were recorded: age, sex, major chronic diseases, functional status, voiding method, total residing days, main presenting symptoms at hospitalization for symptomatic urinary tract infections, and microorganisms grown in urine cultures with their antibiotics susceptibility.
Results: During the period of study, incidence of hospitalization owing to symptomatic urinary tract infection was 1.82 per 1000 resident days. Multiple logistic regression analysis showed that those who had renal and urological diagnoses were associated with an increased risk. The five most prevalent microorganisms isolated from urine samples were, in descending order, Escherichia coli、Pseudomonas aeruginosa、Proteus mirabilis、Klebsiella pneumoniae, and Enterococcus spp. The percentage of extended-spectrum beta-lactamase producing strains accounted for 33.3% of E. coli and 46.7% of K. pneumoniae, respectively. Five percents of isolates were Acinetobacter baumannii, which were generally resistant to most commonly used antimicrobial agents, not to mention the appearance of pandrug-resistant strain of A. baumannii. In general, the results of antimicrobial susceptibility were found to be at least as worse as those of the medical center where the nursing home was located.
Conclusion: Our study showed the incidence of symptomatic urinary tract infections in the nursing home is not low. The antimicrobial susceptibility of the causing pathogens in the nursing home was similar to that in the medical center. On face of the high incidence and drug resistance in Taiwan, further prospective epidemiological studies concerning infection control, prevention, diagnosis, antimicrobial therapy, and non-antimicrobial treatment, are urgently needed.