居家照護個案因泌尿道感染住院之盛行率及相關危險因子探討

Prevalence of Admission Rate and Its Related Risk Factors Due to Urinary Tract Infections among Home Care Residents

10.7023/TJFM.201009.0110

李明昕(Ming-Hsin Lee)；邱偉嘉(Wei-Chia Chiu)；黃麗娟(Li-Chuan Huang)；王建楠(Jiang-Nan Wang)；蘇世斌(Shih-Bin Su)

home care ； urinary tract infection ； bacteriuria ； chronic-ill elderly patient ； risk factor

台灣家庭醫學雜誌

20卷3期（2010 / 09 / 01）

110 - 121

繁體中文

目的：長期照護機構住民的泌尿道感染因其高發生率而被廣泛重視。而嚴重功能喪失之居家照護個案亦屬高危險群，但國內外針對此一族群之相關流行病學資料缺乏。 方法：分析台灣南部某醫學中心於2008年1月1日至12月31日期間曾接受居家照護的所有個案。收集資料包括年齡、性別、功能狀態、主要慢性疾病、個案來源及看護國籍、使用經尿道導尿管之有無、因泌尿道感染住院時的主要症狀、尿液培養中的菌種、住院天數及預後等。 結果：2008年曾接受居家照護的個案共573人，因各種疾病而住院者有191人（283人次）。其中有107人(18.67%)發生共141人次的「症狀性泌尿道感染」而住院，佔所有住院人次的49.82%。分析發現，「年齡」、「行走能力爲完全依賴者」、「失智症」、「神經性膀胱」「脊髓損傷」、「慢性腎衰竭」和「經尿道導尿管」是症狀性泌尿道感染住院之獨立危險因子。分析尿液培養菌種，未使用經尿道導尿管者以E. coli最多，而使用經尿道導尿管者則以Pseudomonas spp.最多，產生廣譜乙醯按(extended-spectrum beta-lactamase)的E. coli及K. pneumoniae亦以使用導尿管者爲多。 結論：本研究發現居家照護個案因症狀性泌尿道感染住院者盛行率甚高。希望藉由一些介入措施改善危險因子進而減少症狀性泌尿道感染發生或降低抗生素抗藥性菌種產生機會。

Purposes: There are concerns about urinary tract infections (UTIs) in residents of long-term care facilities for high incidence rate. However, the epidemiologic data of UTIs was rare for patients with severe functional impairment in home care setting. Methods: We conducted a study to collect the data of residents receiving home care service in a medical center in southern Taiwan from Jan. 1 2008 to Dec. 31 2008. We obtained the data from medical records, including age, gender, functional status, major chronic diseases, patients source, nationality of care-giver, with indwelling urethral catheter or not, main presenting symptoms at hospitalization for symptomatic UTIs, and microorganisms grown in urine cultures. Results: In total, 573 residents received home care service during this period. There were 191 residents with 283 admissions in different disease. The prevalence rate of hospitalized UTIs was 18.67% (107 subjects and 141 admissions). Multiple logistic regression analysis showed that those who were older, dependent in walking ability, or who had dementia, neurogenic bladder, spinal cord injury, chronic renal failure or indwelling urethral catheter were independent predictors of UTIs. The most frequent microorganisms were E. coli isolated from patients without urethral catheter and, in contrast, Pseudomonas spp. from patients with urethral catheter. The extended-spectrum beta-lactamase producing E. coil and K. pneumoniae isolated from whom with urethral catheter was more prevalent than whom without. Conclusions: This study showed the prevalence of symptomatic UTIs in home care setting is relatively high. How to reduce the admission rate and resistant rate of microorganism by some interventions may need more concern.

1. Boscia, J.A.,Kobasa, W.D.,Knight, R.A.,Abrutyn, E.,Levison, M.E.,Kaye, D.(1986).Epidemiology of bacteriuria in an elderly ambulatory population.Am J Med,80,208-14.
2. Brandeis, G.H.,Baumann, M.M.,Hossain, M.,Morris, J.N.,Resnick, N.M.(1997).The prevalence of potentially remediable urinary incontinence in frail older people: a study using the Minimum Data Set.J Am Geriatr Soc,45,179-84.
3. Chan, T.T.,Hwang, L.C.,Tjung, J.J.,Chang, C.M.(2005).Hospitalized urinary tract infections in residents of a nursing home.Taiwan Geriatr Gerontol,1,65-77.
4. Cox, A.J.,Hukins, D.W.,Sutton, T.M.(1989).Infection of catheterised patients: bacterial colonisation of encrusted Foley catheters shown by scanning electron microscopy.Urol Res,17,349-50.
5. Eberle, C.,Winsemius, M.D.,Garibaldi, R.A.(1993).Risk factors and consequences of bacteriuria in non-catheterized nursing home residents.J Gerontol,48,M266-M271.
6. Eriksen, H.M.,Iversen, B.G.,Aavitsland, P.(2004).Prevalence of nosocomial infections and use of antibiotics in long-term-care facilities in Norway, 2002 and 2003.J Hosp Infect 2004,57,316-20.
7. Evans, J.G.(ed.),Williams, T.F.(ed.),Beattie, B.L.(ed.)(2000).Oxford Textbook of Geriatric Medicine.Oxford:Oxford University Press.
8. Geerlings, S.E.,Stalk, R.P.,Camps, M.J.L.(2000).Asymptomatic bacteriuria may be considered a complication in women with diabetes.Diabetes Care,23,744-9.
9. Griebling, T.L.(2005).Urologic diseases in america project: trends in resource use for urinary tract infections in men.J Urol,173,1288-94.
10. Gross, J.S.,Neufeld, R.R.,Libow, L.S.,Gerber, I.,Rodstein, M.(1988).Autopsy study of the elderly institutionalized patient.Arch Intern Med,148,173-6.
11. Kamel, H.K.(2004).Managing urinary tract infections in the nursing home: myths, mysteries and realities.Internet J Geriatr Gerontol,1(2)
12. Ko, M.C.,Liu, C.K.,Woung, L.C.(2008).Species and antimicrobial resistance of uropathogens isolated from patients with urinary catheter.Tohoku J Exp Med,214,311-9.
13. Landi, F.,Cesari, M.,Onder, G.(2004).Indwelling urethral catheter and mortality in frail elderly women living in community.Neurourol Urodyn,23,697-701.
14. Mahoney, F.I.,Barthel, D.(1965).Functional evaluation: the Barthel Index.Maryland State Med J,14,56-61.
15. Mcnulty, C.,Freeman, E.,Smith, G.(2003).Prevalence of urinary catheterization in UK nursing homes.J Hosp Infect,55,119-23.
16. Muder, R.R.,Brennen, C.,Wagener, M.M.(1992).Bacteremia in a long term care facility: a five-year prospective study of 163 consecutive episodes.Clin Infect Dis,14,647-54.
17. Nicolle, L.E.(2000).Urinary tract infections in longterm care facility residents.Clin Infect Dis,31,757-61.
18. Nicolle, L.E.(1997).Asymptomatic bacteriuria in the elderly.Infect Dis Clin North Am,11,647-62.
19. Nicolle, L.E.(2002).Resistant pathogens in urinary tract infections.J Am Geriatr Soc,50,230-5.
20. Nicolle, L.E.(2001).the SHEA Long-Term-Care Committee: Urinary tract infections in longterm-care facilities.Infect Control Hosp Epidemiol,22,167-75.
21. Nicolle, L.E.,mcintyre, M.,Hoban, D.(1994).Bacteremia in a long term care facility.Can J Infect Dis,5,130-2.
22. Nicolle, L.E.,mcintyre, M.,Zacharias, H.,macdonell, J.(1984).Twelve month surveillance of infections in institutionalized elderly men.J Am Geriatr Soc,32,513-9.
23. Nicolle, L.E.,Strausbaugh, L.J.,Garibaldi, R.A.(1996).Infections and antibiotic resistance in nursing homes.Clin Microbiol Rev,9,1-17.
24. Nicolle, L.E.,Strausbaugh, L.J.,Garibaldi, R.A.(2002).Urinary tract infection in geriatric and institutionalized patients.Urinary Tract Infect Sexually Transmitted Dis,12,51-5.
25. Rodhe, N.,Sigvard, Mölstad,Englund, Lars,Svärdsudd, Kurt(2006).Asymptomatic bacteriuria in a population of elderly residents living in a community setting: prevalence, characteristics and associated factors.Fam Pract,23,303-7.
26. Rogers, M.A.M.,Fries, B.E.,Kaufman, S.R.(2008).Mobility and other predictors of hospitalization for urinary tract infection: a retrospective cohort study.BMC Geriatrics,8(31)
27. Sorbye, L.W.,Finne-Soveri, H.,Ljunggren, G.,Topinkova, E.,Bernabei, R.(2005).Indwelling catheter use in home care; elderly, aged 65+, in 11 different countries in Europe.Age Ageing,34,377-81.
28. Tambyah, P.A.,Maki, D.G.(2000).Catheter-associated urinary tract infection is rarely symptomatic.Arch Intern Med,160,678-82.

1. 蔡美菊,張國軒,張宏哲,林秀娜,白淑芬(2017)。接受居家護理老人住院情形及其相關因素探討。長期照護雜誌，21(1)，53-75。
2. 劉玉玲,黃明喜,黃子庭,陳志道,吳待芬,江宏彬(2016).長期留置導尿管相關泌尿道感染高危險因子評估量表的發展與測試.長期照護雜誌,20(2),149-165.
3. 謝東呈,邱佳慧(2011)。紫色尿袋症候群和生物膜在泌尿道感染中所扮演的角色。弘光學報，65，109-125。