加護病房內的多重抗藥性細菌感染與控制

Infection Control of Multiple-Drug Resistant Pathogens at Intensive Care Units

10.30035/TCCM.201003.0005

盛望徽(Wang-Huei Sheng)

多重抗藥性細菌 ； 加護病房 ； 感染控制 ； Multiple-drug resistant pathogens ； Intensive care units ； Infection control

重症醫學雜誌

11卷1期（2010 / 03 / 01）

32 - 36

繁體中文

院內感染是醫療品質的重要指標，加護病房中照顧之低免疫力之病患、長期密集抗生素使用和抗藥性菌種交叉感染，容易導致高度抗藥性細菌的院內感染群突發，這些抗藥性菌株現在已散佈至醫院外造成社區感染。不論在社區或醫院中，高度抗藥性細菌感染的盛行率已逐漸上升。有關院內抗藥性菌種增加的主要控制措施，便是對抗藥性細菌院內感染群突發的管理，包括感染病患集中照顧、抗藥性細菌監測、隔離或防護措施、儘早出院及合理抗生素之使用都是有效的方式。加護病房必須提供標準之洗手設備、採取隔離作業、有足夠的病床空間以及良好通風，以防止抗藥性細菌散佈。加護病房內發生多重抗藥性細菌之群突發會增加病患的住院日數以及額外花費，產生之併發症及死亡率均相對提高，因此醫護人員及醫療主管應加強院內感染之預防與落實執行感染管制。

Multiple-drug resistant pathogens, such as methicillin-resistant Staphylococcus aurues (MRSA), vancomycin-resistant Enterococcus (VRE), and multiple-drug resistant Acinetobacter baumannii (MDRAB) have recently emerged as important nosocomial pathogens, especially in intensive care units, where outbreaks due to these organisms are common. Infections due to multidrug resistant (MDR-) pathogens have a significant impact on the length of extra hospital stay and extra charges for their medical care. Treatment of infections due to these MDR-pathogens are is difficult, since this microorganism frequently is resistant to multiple antimicrobials and usually colonized or infected in immunocompromised hosts. The low number of effective antimicrobials, together with the occurrence of infections in critically ill patients, might be responsible for an increase in infection-attributable mortality. MDR-pathogens are known to survive on inert surfaces and colonize the skin of healthy human for periods longer than weeks. Some investigations of MDR-pathogens outbreaks established that devices (such as ventilator circuits, humidifiers, respirometers, and pressure transducers) and hand carriage by the hospital staff were the main reservoirs in ICUs. Vigorous infection control policy, monitoring the adherence to the policy, appropriate therapy for infection once infection occurred are crucial to reduce the cost of resources and improve the survival of the patients.

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