探討抗生素管理計畫對院內抗藥性菌種分佈之影響

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Title:	探討抗生素管理計畫對院內抗藥性菌種分佈之影響 Impact of Antimicrobial Stewardship Program Interventions on the distribution of drug-resistant bacteria in a Hospital in Southern Taiwan
Authors:	吳雅鳳
Contributors:	醫務管理系陸海林洪萬吉
Keywords:	抗藥性多重抗藥菌抗生素管理計畫 Drug resistance Multi-drug resistant organisms Antimicrobial Stewardship Program
Date:	2017
Issue Date:	2018-01-11 11:44:03 (UTC+8)
Abstract:	自1928年青黴素（Penicillin）被發現後，開啟了抗生素治療的時代，隨著抗生素被廣泛的使用，人類面臨了新的危機―多重抗藥性微生物(multidrug-resistant organisms ,簡稱MDROs)的出現，威脅著人類的健康，造成人類的健康衝擊。根據國家衛生研究院進行的「台灣微生物抗藥性監測計畫(Taiwan Surveillance of Antimicrobial Resistance, TSAR)」第I到VII期(1998年~2010年)調查顯示，國內近十年來多重抗藥性細菌(MDROs)的盛行率有逐步上升趨勢，已是全世界最嚴重的地區之一。美國Food and Drug Administration (FDA)核准上市的抗生素自1983年至2011年數量逐年下降，過去20年來並沒有推出新一類的抗生素，依照統計數字推估預計5~10年將沒有新作用機轉的抗菌藥物可供臨床使用。衛生福利部自102年起推行抗生素管理計畫，希望藉由計畫施行，能讓大家正視這抗藥性的問題，更有效率的、積極地增進抗生素合理使用。因為參與抗生素管理計畫，了解抗生素的濫用造成問題的嚴重性，想藉由收集院內近6年來抗藥性菌種分析，了解院內的菌種抗藥性分布趨勢與計畫施行前後對多重抗藥菌種產生狀況是否有改善，並進一步探討病人族群的差異，是否有哪些病人更易因抗生素濫用而導致多重抗藥菌種感染，增加醫療成本支出，更需要注意審慎的使用抗生素。依據收集的資料顯示院內臨床最常見之致病細菌為:大腸桿菌(Escherichia coli)、克雷伯氏肺炎桿菌(Klebsiella pneumoniae)、綠膿桿菌(Pseudomonas aeruginosa) 、鮑氏不動桿菌(Acinetobacter baumannii) 、金黃色葡萄球菌 (Staphylococcus aureus)及腸球菌(Enterococcus spp)等，本研究監控這些菌種的抗藥比例也是逐年上升的正成長趨勢，並且在病人族群方面是以加護病房和血液腫瘤科病人以及高齡族群檢出抗藥性菌種比例較高。 Since the discovery of penicillin in 1928, the era of antibiotic therapy has been opened. As the antibiotics are widely used, humans face a new crisis - the multidrug-resistant organisms (MDROs) appear to threaten the human health, the problems of drug resistance have caused human health shocks. According to the National Health Research Institutes "Taiwan Surveillance of Antimicrobial Resistance (TSAR)" I-VII (1998 ~ 2010) survey, the domestic multi-drug resistant organisms (MDROs ) Has risen gradually and is one of the most serious in the world. U.S. Food and Drug Administration(FDA) approved the listing of antibiotics from 1983 to 2011 the number of declining , the past 20 years has not introduced a new class of antibiotics, according to statistics estimated that 5 to 10 years will not have a new role in the machine Antibiotics can be used clinically .The Ministry of Health and Welfare has implemented an National Action Plan. Antimicrobial Stewardship Program since 2013. It is hoped that through the implementation of the program, we will allow you to face up to the problem of drug resistance and promote the rational use of antibiotics. Because the participation in antibiotic management program, to understand the abuse of antibiotics caused serious problems, would like to collect the hospital nearly six years of drug-resistant strains of bacteria, to understand our hospital strains of drug resistance trends and plans before and after the implementation of multiple anti- Whether there is improvement in the production of the situation, and further explore the patient population which patients are more likely to cause antibiotic abuse caused by multiple drug-resistant strains of infection, and increase the cost of medical expenses, but also the need for prudent use of antibiotics . According to the data collected, the common pathogenic bacteria in our hospital are: Escherichia coli、Klebsiella pneumoniae 、Pseudomonas aeruginosa、Acinetobacter baumannii、 Staphylococcus aureus and Enterococcus spp. We monitor the proportion of these strains is also increasing the trend of rising year by year, and in the patient population is the intensive care unit and blood cancer patients and elderly .A higher proportion of drug-resistant bacteria
Relation:	電子全文公開日期：2019-07-26，學年度：105，77頁
Appears in Collections:	[Dept. of Hospital and Health (including master's program)] Dissertations and Theses

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