| Abstract: | 背景及目的：長期照護機構住民容易由照護行為及污染環境造成交叉傳播感染。多重抗藥性細菌(Multi-drug resistant organisms, MDROs)的移生或感染是長照機構住民健康的重大威脅，然而國內少有研究探討長照機構住民檢出抗藥性細菌與慢性疾病、放置侵入性管路及抗生素使用之關聯性，故本研究之目的在探討長期照護機構住民多重抗藥性細菌移生分布狀況及其危險因子。
方法：研究採回溯性資料分析，蒐集自2018年1月1日至2019年12月31日於中部某區域教學醫院收治住院之住宿型長期照護機構住民住院治療及檢驗資料。入院48小時內曾接受喉頭及糞便抗藥性細菌主動篩檢監測之個案，由篩檢結果分為檢出MDROs與未檢出MDROs兩組。統計分析以皮爾森卡方檢定 (Pearson's chi-squared test)、t檢定等方法比較二組各項臨床數據，並建立單變項與多變項羅吉斯迴歸模型、計算勝算比(Odds ratio, OR)與其95%信賴區間，探討MDROs移生的相關危險因子。
結果：本研究共納入669位研究對象，於住院時進行抗藥性細菌主動篩檢監測，篩檢結果共279位病人檢出帶有抗藥性細菌，檢出菌株數為317株MDRO，移生盛行率高達41.7%。檢出的抗藥性細菌中，萬古黴素抗性性腸球菌(Vancomycin-resistant Enterococci, VRE)有160株 (23.9%)，Carbapenem抗藥性的克雷白氏肺炎菌(Carbapenem-resistant Klebsiella pneumoniae, CRKP)有126株 (18.8%)，Carbapenem抗藥性的靜止不動桿菌(Carbapenem-resistant Acinetobacter baumannii, CRAB)有31株 (4.6%)。多變項迴歸分析結果顯示，重複住院 (OR= 3.62; p<0.001)、半年內曾入住ICU (OR= 4.53; p< 0.001)、CVC置放(OR= 2.04; p=0.038)、鼻胃管置放(OR= 2.60; p< 0.001)；罹患慢性腎衰竭 (OR= 2.76; p< 0.001)；使用第二代Cephalosporins (OR= 4.74; p< 0.001)、使用第三代Cephalosporins (OR= 2.37; p= 0.01)，與使用其他抗生素(OR= 2.96; p= 0.001)等均為MDROs移生之危險因子。
結論：本研究發現長期照護機構住民入院抗藥性細菌主動篩檢監測，VRE、CRKP及CRAB呈現較高的檢出率。建議在臨床實務上，應關注機構住民之間抗藥性細菌的傳播，例如針對一年內重複住院兩次以上、於住院時曾入住ICU、慢性腎衰竭，以及置放中心靜脈導管、鼻胃管導管等較高風險的住民，應更注意感染風險，例如嚴格執行手部衛生與接觸隔離措施，以減少抗藥性細菌在長照機構的傳播。
Background and Purposes: Residents in long-term care institutions are prone to cross-transmission of infections caused by medical care process and polluted environments. The colonization or infection of multi-drug resistant organisms (MDROs) has been a major threat to the health of residents in long-term care institutions. However, few domestic studies have explored the relationship between drug-resistant bacteria inhabited in residents of long-term care institutions and chronic diseases antibiotic use. Therefore, the purpose of this study was to investigate the distribution of colonization of multidrug-resistant bacteria and its risk factors of residents in long-term care institutions.
Methods: This study was conducted retrospectively and enrolled residents of long-term care institutions who were hospitalized to a regional teaching hospital in central Taiwan during the period from January 1, 2018 to December 31, 2019. Medical treatment and laboratory data of hospitalization were collected. Active surveillance of throat and fecal drug-resistant bacteria were performed within 48 hours of admission and participants were divided into two groups, that is, present with and without MDROs. For statistical analysis, Pearson's chi-squared test and two-sample t test were employed to compare distributions of clinical data between these two groups. Univariate and multivariate logistic regression models were used to calculate odds ratios (OR) and their 95% confidence intervals to identify factors associated with the colonization of MDROs.
Results: A total of 669 subjects were included in this study. Among them, 279 participants exhibited drug-resistant bacteria. There were 317 isolates of MDROs obtained. The prevalence rate of MDROs in the studied group was 41.7%. Of the detected drug-resistant bacteria, 160 isolates (23.9%) were vancomycin-resistant Enterococci (VRE), 126 (18.8%) were Carbapenem-resistant Klebsiella pneumoniae (CR-KP), and 31 (4.6%) were Carbapenem-resistant Acinetobacter baumannii (CRAB). Multivariable regression analysis revealed that repeated hospitalization (OR= 3.62; p<0.001), ICU admission within six months (OR= 4.53; p< 0.001), CVC placement (OR= 2.04; p=0.038), nasogastric , and the uses of second-generation Cephalosporins (OR= 4.74; p< 0.001), third-generation Cephalosporins (OR= 4.74; p< 0.001) 2.37; p= 0.01) and other antibiotics (OR= 2.96; p= 0.001) were risk factors for the colonization of MDROs in hospitalized residents of long-term care institutions.
Conclusion: This study demonstrated that VRE, CRKP and CRAB had a high detection rate in residents of long-term care institutions employing active surveillance method. This suggests that the transmission of MDROs among residents of long-term care institutions should be prevented. Residents admitting twice or more to a hospital a year, experiencing ICU admission, suffering from chronic renal failure, being inserted with central venous catheters or with nasogastric tubes had a higher risk of infection. Consequently, strict hand hygiene and contact isolation should be implemented to reduce the spread of MDROs in long-term care institutions. |
