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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in the practice of infectious diseases. Clin InfectDis 2000;31:1414-22.

4. Tresch DD, Simpson WM Jr, Burton JR:Relationship of long-term and acute-carefacilities. The problem of patient transfer andcontinuity of care. J Am Geriatr Soc 1985;33:819-26.

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6. Stone ND, Ashraf MS, Calder J, et al:Surveillance definitions of infections in long-termcare facilities: revisiting the McGeer criteria.Infect Control Hosp Epidemiol 2012;33:965-77.

7. Cotter M, Donlon S, Roche F, et al: Healthcare-associated infection in Irish long-term carefacilities: results from the First NationalPrevalence Study. J Hosp Infect 2012;80:212-6.

8. Dwyer LL, Harris-Kojetin LD, Valverde RH, et al:Infections in long-term care populations in theUnited States. J Am Geriatr Soc 2013;61:342-9.

9. Marchi M, Grilli E, Mongardi M, et al: Prevalenceof infections in long-term care facilities: how toread it? Infection 2012;40:493-500.

10. Heudorf U, Boehlcke K, Schade M: Healthcare-associated infections in long-term care facilities(HALT) in Frankfurt am Main, Germany, Januaryto March 2011. Euro Surveill 2012;17. pii: 20256.

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.

13. Das R, Perrelli E, Towle V, et al: Antimicrobialsusceptibility of bacteria isolated from urinesamples obtained from nursing home residents.Infect Control Hosp Epidemiol 2009;30:1116-9.

14. Mendelson G, Hait V, Ben-Israel J, et al:Prevalence and risk factors of extended-spectrumbeta-lactamase-producing Escherichia coli andKlebsiella pneumoniae in an Israeli long-term carefacility. Eur J Clin Microbiol Infect Dis2005;24:17-22.

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.

17. Mylotte JM: Nursing home-acquired pneumonia.Clin Infect Dis 2002;35:1205-11.

18. Albrich WC, Monnet DL, Harbarth S: Antibioticselection pressure and resistance in Streptococcuspneumoniae and Streptococcus pyogenes. Emerg

Infect Dis 2004;10:514-7.

19. Yoshikawa TT, Norman DC: Approach to feverand infection in the nursing home. J Am GeriatrSoc 1996;44:74-82.

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