長期照護機構常見感染症 及抗藥性菌種問題...143 中華民國103 年6...
TRANSCRIPT
143
中華民國 103 年 6 月第二十四卷第三期
前 言
101
28 9
( )
(
)
[1]
長期照護機構常見感染症及抗藥性菌種問題
1,2,3 1,3 1 2 1,2,3
國立成功大學醫學院附設醫院 1感染管制中心 2內科部老年科 3感染病科
( )
感控雜誌 2014:24:143-
149
關鍵詞:
103 1 22 103 4 10 70403 138
(06) 2353535 3596
144 長期照護機構常見感染症及抗藥性菌種
感染控制雜誌
[2]
[3]
長期照護機構常見感染疾病及致病菌
[4]
[5]
2012
Stone ND 1991
McGeer
[6]
1.8 13.5
0.3~4.7
0.19~2.4
5.2~11.8
1.4~2.5 1.0~3.2
( )
3.7~11.8% [7~12]
表一 國外長照機構住民感染盛行率
[參考資料] 作者/病人數 統計期間 機構型態/地點 感染率 下呼吸道 泌尿道 皮膚 腸胃道
盛行率 感染 感染 感染 感染
[7] Cotter et al/4,170 2010 長照機構/愛爾蘭 3.7% 1.0% 1.9% 0.7% Nil
[8] Dwyer LL/12,270 2004/2007 護理之家/美國 11.8% 2.2% 5.2% 1.6% Nil
[9] Marchi M/812 2003~2006 長照機構/義大利 11.5% 5.7% 2.6% 1.9% Nil
(6 次追蹤)
[10] Heudorf U/3,732 2011 長照機構/德國 4.3% 1.1% 1.2% 0.7% 0.3%
[11] Eriksen/17,174/11,465 2002/2003 長照機構/挪威 7.3/7.6% 1.2/1.6% 3.8/3.8% 2.0/1.8% Nil
(兩次追蹤)
[12] Eikelenboom-Boskamp/ 2007~2009 護理之家/荷蘭 6.7~7.6% 2.5% 3.8% Nil 0.3%
1,275~1,772
145黃基彰、柯文謙、李奕萱等
中華民國 103 年 6 月第二十四卷第三期
2.7~7%
泌尿道感染
[5]
1.2~5.2% [7~12]
Enterobacteriaceae
Escherichia coli Proteus
mirabilis
Klebsiella pneumoniae,
Providencia spp., Citrobacter spp.,
Morganella morganii, Enterobacter spp.,
Pseudomonas aeruginosa
Enterococcus spp. [5]
E. coli co-
trimoxazole ampicillin
50~60% P. mirabilis ampicillin
co-trimoxazole 20~30%
[13] O’Fallon
2003 7%
2005 13%
ciprofloxacin co-trimoxazole
ampicillin/sulbactam
80% Extended-
spectrum -lactamases-(ESBL)
10~60% [14]
E. coli K. pneumoniae P.
aeruginosa P. mirabilis ESBL-
producing E. coli K. pneumoniae
33% 46%
[15]
下呼吸道感染
[7~12]
6~10
(
)
1.0~5.7%
[ 7 ~ 1 2 ]
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis Staphylococcus
aureus
Chlamydophila pneumoniae
Mycoplasma pneumonia [12,16]
146 長期照護機構常見感染症及抗藥性菌種
感染控制雜誌
E. coli K.
pneumoniae P. aeruginosa
penicillin-resistant S.
pneumoniae
Quinolone-resistant H. influenzae
ESBL-producing K. pneumoniae E.
coli Methicillin-resistant S. aureus
(MRSA) [17,18]
Penicillin-resistant S. pneumoniae
5%
7~12%
31~43% 50% [18]
Quinolone-resistant H. influenzae
8~28%
P.
aeruginosa E. coli S. aureus
S. pneumoniae
Penicillin 67.7% 23.9%
軟組織感染
0.7~2.0%
[7~12]
65%
S. aureus
Streptococcus pyogenes
Enterobacteriaceae Pseudomonas spp.
Enterococcus spp.
[12] MRSA
50~60%
vancomycin-resistant enterococci
[12]
胃腸道感染
0.3~0.5% [10,12]
Clostridium
difficile Clostridium perfringens,
noroviruses rotaviruses S. aureus
Salmonella [12] C. difficile
9~26%
[12] Noroviruse
18
147黃基彰、柯文謙、李奕萱等
中華民國 103 年 6 月第二十四卷第三期
2
80%
11 4
[20,21] 2005
2006
Norovirus
85%
Salmonella S. aureus C.
perfringens [21]
結 論
參考文獻
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11. Eriksen HM, Iversen BG, Aavitsland P:Prevalence of nosocomial infections and use ofantibiotics in long-term care facilities in Norway,2002 and 2003. J Hosp Infect. 2004;57:316-20.
12. Eikelenboom-Boskamp A, Cox-Claessens JH,Boom-Poels PG, et al: Three-year prevalence ofhealthcare-associated infections in Dutch nursinghomes. J Hosp Infect 2011;78:59-62.
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15. 陳鼎達、黃麗卿、鍾嫈嫈等:護理之家住民因
148 長期照護機構常見感染症及抗藥性菌種
感染控制雜誌
泌尿道感染而住院之調查研究。台灣老年醫學會雜誌 2005;1:65-78.
16. El-Solh AA, Niederman MS, Drinka P: Nursinghome-acquired pneumonia: a review of riskfactors and therapeutic approaches. Curr Med ResOpin 2010;26:2707-14.
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Infect Dis 2004;10:514-7.
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20. Hall AJ, Eisenbart VG, Etingue AL, et al:Epidemiology of foodborne norovirus outbreaks,United States, 2001-2008. Emerg Infect Dis2012;18:1566-73.
21. Kirk MD, Veitch MG, Hall GV: Gastroenteritisand food-borne disease in elderly people living inlong-term care. Clin Infect Dis 2010;50:397-404.
149黃基彰、柯文謙、李奕萱等
中華民國 103 年 6 月第二十四卷第三期
Common Infections and Antimicrobial-
resistant Pathogens in Long-term Care
Facility
Chi-Chang Huang1,2,3, Wen-Chien Ko1,3, Yi-Hsuan Lee1, Deng-Chi Yang2, Chia-Ming Chang1,2,3
1Center of Infection Control, 2Division of Geriatrics and Gerontology, Department of Internal Medicine,3Division of Infectious Disease, Department of Internal Medicine, National Cheng Kung University
Hospital, Tainan, Taiwan
Decreasing birth rates and an aging population have resulted in increaseddemand for long-term care facilities (LTCFs) in Taiwan. Many LTCF residents withmultimorbidity and polypharmacy experience invasive treatments, functionaldecline, and impaired immunity; infection is the leading cause of frequenthospitalization and mortality in this population. LTCFs have also been reported tobe highly associated with antimicrobial resistance. This study reviewsepidemiological data and characteristics of common infectious diseases andantimicrobial resistances in LTCFs to help caregivers develop a comprehensiveunderstanding of infections in the elderly.
Key words: Long-term care facility, infection