某矯正機關抗生素使用評估：強調治療皮膚與軟組織感染的抗生素的合宜性

Antibiotic Stewardship Program Emphasizing the Proper Treatment of Skin and Soft Tissue Infection in a Correctional Institute

林炎正(Yan-Jeng Lin)；吳振誠(Chen-Cheng Wu)；陳麗資(Li-Zi Chen)；吳閔雯(Min-Wen Wu)；洪冬哲(Tong-Che Hong)；郭靜燕(Ching-Yen Kuo)；鄭舒倖(Shu-Hsing Cheng)

矯正機關 ； 抗甲氧苯青黴素金黃色葡萄球菌 ； 皮膚與軟組織感染 ； 抗生素 ； Correctional Institute ； Methicillin-resistant Staphylococcus aureus (MRSA) ； Skin and soft tissue infection ； Antibiotics

醫學與健康期刊

8卷2期（2019 / 09 / 01）

75 - 84

繁體中文

台灣自西元2013（民國102年）年後，受刑人納入全民健康保險，矯正機關的醫療質量有大幅的提升。而矯正機關屬人口密集單位、傳染病容易在群體內傳播，也衍生出矯正機關的感染管制人才不足、抗藥性細菌滋長、及抗生素過度使用等問題。本研究探討本院所支援當地的某矯正機關門診，在2016年1月至2017年12月間總共看診58,767人次，有4,433（7.5%）有急性感染症的診斷，其中81.5%診斷為皮膚與軟組織感染。總共有150人次（3.4%）進行細菌培養，歸人統計共102人中，培養陰性為53人（52.0%）。皮膚與軟組織相關細菌培養者共33人中，抗甲氧苯青黴素金黃色葡萄球菌（MRSA）佔63.6%。共2,677人接受抗生素治療，平均每次療程11.5天，共接受13.2定義每日劑量（DDD）的抗生素。抗生素種類以amoxicillin及amoxicillin/clavulanic acid佔最多達59%，而可以對抗MRSA的藥物doxycycline、trimethoprim/sulfamethoxazole、fusidate只佔10.2%。以上結果顯示，矯正機關內之抗生素處方並未考量最常見的MRSA所致皮膚與組織軟組織感染，仍有改善的空間。

Correctional institutes have some health issues, included overcrowding, easy spread of transmissible diseases, lack of infection control personnel, overuse of antibiotics, and emergence of antibiotic resistance. These remained unaddressed until 2013, when prison inmates were granted the right to enroll in Taiwan’s National Health Insurance copayment program. This study explored the spectra of infectious diseases, causal pathogens, and approaches to treatment in a prison in Taoyuan. Between 2016 and 2017, the prison had 58,767 ambulatory visits. Antibiotics were given in 4,433 (7.5%) visits, 87.5% of the visits being for skin and soft tissue infections. One hundred fifty samples (3.4%) obtained from 102 patients were sent for culturing. Fifty-three (52.0%) showed negative growth. Thirty-three patients provided bacterial cultures for skin and soft tissue infections, with 63.6% of pathogens Methicillin-resistant Staphylococcus aureus (MRSA). Totally 2,677 inmates had received antibiotics, receiving 13.2 defined daily dose for an average of 11.5 days. Amoxicillin, amoxicillin/clavulanic acid made up 59% of antimicrobial prescriptions. Antimicrobials recommended for MRSA infections(e.g.,doxycycline, trimethoprim/sulfamethoxazole, and fucidic acid)only made up 10.2%. In conclusion, healthcare professionals in this prison need updating regarding the choice of antibiotics available with particular attention paid to those more appropriately prescribed for MRSA-related skin and soft tissue infections.

1. 陳志強, CC,謝至鎠, JG,邱雲柯, YC,黃亮凱, LK(2018)。矯正機關收容人納入二代健保前後之門診使用狀況分析─以花蓮監獄為例。台灣家醫誌，28，9-17。
   連結：
2. Centers for Disease Control and Prevention(2003).Methicillin-resistant Staphylococcus aureus infections in correctional facilities---Georgia, California, and Texas, 2001-2003.MMWR,52,992-996.
3. Centers for Disease Control and Prevention(2001).Methicillin-resistant Staphylococcus aureus skin or soft tissue infections in a state prison---Mississippi, 2000.MMWR,50,919-922.
4. Chen, YS(2013).Guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections in Taiwan.Journal of Microbiol, Immun Infect,46,147-150.
5. David, MZ,Mennella, C,Mansour, M,Boyle-Vavra, S,Daum, RS(2008).Predominance of methicillin-resistant Staphylococcus aureus among pathogens causing skin and soft tissue infections in a large urban jail: risk factors and recurrence rates.J Clin Microbiol,46,3222-3227.
6. Federal Bureau of Prisons. Management of methicillin-resistant Staphylococcus aureus (MRSA) infection. 2005. Available from: http://www.bop.gov/news/PDFs/mrsa.pdf.Accessed January 22, 2019
7. Haysom, L,Cross, M,Anastasas, R,Moore, E,Hampton, S(2018).Prevalence and risk factors for methicillin-resistant Staphy-lococcus aureus (MRSA) Infections in Custodial Populations: a systematic review.J Correct Health Care,24,197-213.
8. Malcolm, B(2011).The rise of methicillin-resistant Staphylococcus aureus in U.S. correctional populations.J Correct Health Care,17,254-265.
9. Miko, BA,Befus, M,Herzig, CTA(2015).Epidemiological and Biological Determinants of Staphylococcus aureus Clinical Infection in New York State Maximum Security Prisons.Clin Infect Dis,61,203-210.
10. Wang, WY,Chiueh, TS,Sun, JR,Tsao, SM,Lu, JJ(2012).Molecular typing and phenotype characterization of methicillin-resistant Staphylococcus aureus isolates from blood in Taiwan.PLOS ONE,7,e30394.
11. World health organization collaborative center for drug statistics methodology.ATC/DDD index 2019. Available from: https://www.whocc.no/atc_ddd_index/. Accessed January 20, 2019.
12. 中時電子報：二監爆群聚流感疫情已控制。https://tw.news.yahoo.com/%E4%BA%8C%E7%9B%A3%E7%88%86%E7%BE%A4%E8%81%9A%E6%B5%81%E6%84%9F-%E7%96%AB%E6%83%85%E5%B7%B2%E6%8E%A7%E5%88%B6-215006788.html。引用1/20/2019。Chinatimes. The Kaohsiung Second Prison broke out and the flu epidemic has been controlled. Avialble from : https://tw.news.yahoo.com/%E4%BA%8C%E7%9B%A3%E7%88%86%E7%BE%A4%E8%81%9A%E6%B5%81%E6%84%9F-%E7%96%AB%E6%83%85%E5%B7%B2%E6%8E%A7%E5%88%B6-215006788.html. Accessed January 20, 2019. [In Chinese]
13. 行政院研究發展考核委員會, development and evaluation commission(2012)。,台北=Taipei:行政院研考會=Research, development and evaluation commission, Executive Yuan。
14. 法務部：中華民國法務統計年報(2017年)。http://www.rjsd.moj.gov.tw/RJSDWeb/book/Book.aspx?category_id=4。引用1/20/2019。Ministry of Justice. National annual statistics of justice (2017). Available from:http://www.rjsd.moj.gov.tw/RJSDWeb/book/Book.aspx?category_id=4. Accessed January 20, 2019. [In Chinese]
15. 法務部：中華民國法務部統計手冊(2017年)。http://www.rjsd.moj.gov.tw/RJSDWeb/book/Book_Detail.aspx?book_id=303。引用1/20/2019。Ministry of Justice. Statistics manual of justice (2017). Available from: http://www.rjsd.moj.gov.tw/RJSDWeb/book/Book_Detail.aspx?book_id=303.Accessed January 20,2019. [In Chinese]
16. 法務部矯正署桃園監獄：統計輯要。http://www.typ.moj.gov.tw/ct.asp?xItem=452779&CtNode=44932&mp=045。引用1/20/2019。Taoyuan prison, Agency of Corrections, Ministry of Justice.Statistics Abstract.Available from http://www.typ.moj.gov.tw/ct.asp?xItem=452779&CtNode=44932&mp=045.Accessed January 20, 2019. [In Chinese]
17. 健保署=National Health Insurance Administration(2018)。健保署：全民健康保險提供保險對象收容於矯正機關者醫療服務計畫。台北：健保署；2018年9月6日。National Health Insurance Administration: Health service program for the insured inmates in the correctional institutes. Taipei: National Health Insurance Administration. September 06, 2018. [In Chinese]。
18. 衛生福利部疾病管制署：長期照護矯正機關(構)與場所執行感染管制措施及查核辦法。https://www.cdc.gov.tw/File/Get/TgrLp71nMGtiVpwK4ZS1vQ。引用4/28/2019。Taiwan Centers for Disease Control,Ministry of Health and Welfare. Infection control and guidelines governing audition for long-term care facilities and correctional institutes. Available from: https://www.cdc.gov.tw/File/Get/TgrLp71nMGtiVpwK4ZS1vQ. Accessed April 28, 2019. [In Chinese]
19. 鄭舒倖,SH(2006)。矯正機構的感染管制。感染管制雜誌，16，9-16。