- 期刊
台灣東部某區域教學醫院2015～2018年抗藥性趨勢分析
Antibiotic Resistance Trends in a District Teaching Hospital in Eastern Taiwan Isolated in 2015-2018
摘要
多重抗藥性微生物（Multiple drug-resistant organisms，MDROs）一直為院內感染管制中棘手的問題，本研究為探討自2015年1月1日至2018年12月31日東部某區域教學醫院抗藥性趨勢分析，以WHONET統計軟體歸人統計全院抗藥性監測結果，再以SPSS統計軟體進行單因子變異數分析（one-way ANOVA）及斯皮爾曼等級相關係數（Spearman's rank correlation coefficient）進行相關性分析，評估不同細菌抗藥性趨勢及全院抗生素耗用量DID（住院病人抗生素耗用量（DDD）／總住院人日數×1000）之間的關係。結果發現，2015年至2018年住院人日數為11,008～13,140，各種抗生素的耗用量中carbapenems的DID為31～44，fluoroquinolones為129～162，而glycopeptides為28～46。分析相關性後發現，除了carbapenems與carbapenem resistant Pseudomonas aeruginosa （CRPA）具顯著負相關性（p-value 0.003，r ＝-1）以外，其餘皆無顯著差異。由於carbapenems與CRPA雖具顯著差異，但因呈負相關而在臨床上仍不具意義。另外，院外患者攜入之菌種也可能影響全院抗藥性菌種的統計結果，建議可進一步與感管人員討論後加以排除，如此醫院常規監控細菌抗藥性趨勢及DID，才能針對個別抗藥菌種／株加強管制，進而落實微生物劑抗藥性之有效管理。
並列摘要
The emergence of multiple drug-resistant organisms (MDROs) has been a thorny problem in nosocomial infection control. This study was conducted from January 2015 to December 2018 in a district teaching hospital in Eastern Taiwan. We used WHONET and SPSS software for antibiotics monitoring data and regression analyses respectively. The relationship between drug resistance trends and the antibiotic consumption DID (DDD for in patients DDD/Total number of in patients×1000) was evaluated. The DIDs for individual antibiotics carbapenems, fluoroquinolones, and glycopeptides are 31-44, 129-162, and 28-46. There were gradual increases in DID for carbapenems and glycopeptides from 2015-2018. We also calculated the incidence of antibiotics resistant bacteria and correlate the antibiotics resistance trends with antibiotic consumption DID. Although the trends for most antibiotics resistance bacteria did not show significant correlation with DIDs for carbapenems, fluoroquinolones, and glycoepetides, there was a negative correlation between carbapenems DID and CRPA emerging trends (p-value 0.003, correlation coefficient R^2= 0.9933). The negative correlation may not have clinical implication. We still need to gather more clinical information to separate the strains which might be carried in upon hospital admission. It is important for the hospital routinely monitoring the trends of bacterial resistance and antibiotic consumption (DID) for infection control and to reduce the emergence of antibiotic resistance strains.