| Abstract: | 一. 背景及目的:
包氏不動桿菌（Acinetobacter baumannii）造成的院內感染比率不斷上升，更由於近年來台灣地區由於抗生素的濫用，造成抗藥性的節節高升。由國衛院發表最新的2006年第五期「全國微生物抗藥性監測計畫」（TSAR V）顯示醫院院內感染包氏不動桿菌對碳青黴烯類（carbapenem）抗生素產生抗藥性的比率已大幅提昇，碳青黴烯類(carbapenem)為治療AB菌感染的主要後線抗生素，根據TSAR V的資料顯示，對碳青黴烯類具抗藥性的鮑氏不動桿菌﹝Carbapenem resistant Acinetobacter baumannii，簡稱CRAB﹞，由2002年佔包氏不動桿菌之低於3%，於2004年已增加至約16%，2006年更增加至約32%，問題日益嚴重。找出可能的致抗藥性危險因子是本研究的主題
二. 研究對象與方法:
採用回朔性研究方法，收集某區域教學醫院2007年1月至2007年12月的1141筆細菌培養資料, 就MICU sputum culture連續兩套培養出AB菌的病人病歷納入分析,記錄包括年齡,性別,感染前住院天數,使用抗生素的種類,使用的天數,病人的既有疾病(cormorbidity),是否在一個月內有開過刀,是否有侵入性的療程包括插氣管內管和中心靜脈導管(CVP), 多重抗藥性(multi-drug resistant)則定義為對抗生素的敏感性試驗都為中間性(intermediate)和抗藥性(resistants) , MDRAB的病人有38位與36位non-MDRAB的病人做比較分析
三.結果:
抗生素抗藥性組與非抗藥性組就感染前住院天數,年齡,性別,曾經感染, 感染前抗生素使用的種類及使用的天數的危險因子,並無明顯差別,而感染前的開刀,中心靜脈導管放置和氣管內管放置的比較也未達p<0.05.既有疾病慢性心臟衰竭在兩組間有差異p=0.042使用多變數羅吉斯回歸分析來檢驗非獨立的危險因子, 發現年齡的odds ratio=1.003 , 95% CI 0.995-1.011, p=0.470 , 年齡加上慢性阻塞性肺病(COPD)的odds ratio=1.432, 95% CI 1.034-1.983, p=0.031
四.結論:
研究顯示病人的年齡越大和同時感染COPD是MICU病人感染多重抗藥性包氏不動桿菌的危險因子
Background and Objective : The drug resistant rate of Acinetobacter baumannii (AB) have been constantly increased due to the abuse of antimicrobials in Taiwan.
In 2006, the National Health Research Institute (NHRI) reported a surveillance in the fifth edition of Taiwan Surveillance of Antimicrobial Resistance (TSAR V) that Carbapenem resistant have progressively increased in nosocomial infection of AB bacilli. It reported that the resistant rate of A. baumannii in 2002 was 3%，in 2004 it increased to 16%，and until 2006 the rate is going up to 32%.
Materials and Methods : A retrospective surveillance was held in our Intensive care unit to corroborate the above report. We collected patients’ sputum culture as our sample from January, 2006 to December, 2006. The result of Acinetobacter baumannii must show in double culture sampling. We used the logistic regression data mining regarding to patients’ age, sex, hospitalized duration before infection contaminate , antimicrobial used and duration, patients’ co morbidity, patients’ surgical history, patients’ CVP usage history. The multi-drug resistant is defined as those susceptible to antimicrobial agents showed intermediate or resistant.
Result : The result showed the population group of multi-drug resistant of AB is 38 versus to 36 of non-MDRAB, respectively. The odds ratio of age is 1.03 , 95% CI is 0.995-1.011, p value=0.470 , Odds ratio of age plus chronic obstructive airway diseases (COPD) is 1.432, 95% CI 1.034-1.983, p=0.031
Conclusion : chronic obstructive pulmonary disease (C.O.P.D) is the only risk factor to multi-drug resistant of Acinetobacter baumannii (MDRAB) patients. |
