FHIR專區

抗生素抗藥性FHIR格式範例上線！

　　人工智慧（AI）的快速發展，為醫療領域帶來了新的可能性。面對龐大而複雜的抗生素抗藥性資料，除了仰賴人類專業判讀，要如何讓電腦也看得懂，成為得力的助手？國家衛生研究院群體健康科學研究所邱弘毅所長、鄒小蕙老師及助理成捷攜手感染症專家郭書辰醫師、FHIR格式專家楊奕馨老師、李修安博士與李麗惠老師共同協作（圖一），打造適合台灣的抗生素抗藥性資料格式範例，範例可協助將原本分散於檢驗流程各階段的資料系統化、標準化，不僅提升資料紀錄的精準度，也有助於醫院間的資料交換，進一步擴大臨床決策與研究分析的應用價值！
圖一、範例貢獻者
        回顧新冠疫情，微小的病原體在短時間內席捲全球，帶來難以估計的生命損失與社會衝擊，即使疫情遠去仍令人心有餘悸。然而，在我們看不見的角落，另一場更無聲、卻同樣危險的威脅正悄然累積——抗生素抗藥性。當細菌逐漸對原本有效的藥物產生抵抗能力，造成藥物效果變差或是沒有作用，「無藥可醫」將不再只是警告，而可能成為醫療現場的日常。正因如此，世界衛生組織（WHO）已將抗生素抗藥性列為全球十大健康威脅之一。如何有效紀錄、整合並善用抗藥性資料，已成為臨床醫療與科學研究中刻不容緩的關鍵課題。
        假如細菌感染，要如何知道哪一種抗生素有效？在醫院，一次完整的抗生素檢驗包含多個重要步驟。以檢驗痰液中細菌的抗藥性為例，首先會進行顯微鏡檢查，初步觀察檢體(痰液)中是否有細胞 (如上皮細胞)、白血球或細菌等等，此時雖然能觀察到細菌的特徵，但還不能確認種類，因此同時會將檢體中的細菌進行培養與鑑定，在確認細菌種類後，才能進一步測試它對各種抗生素的反應，也就是抗藥性檢測。醫師會根據這些結果，選擇對病患最有效、最合適的抗生素進行治療。(圖二)
     圖片來源: https://www.irasutoya.com/    https://www.flaticon.com *   Icon designed by Freepik, waqasshah, Iconjam.
圖二、抗生素抗藥性檢驗檢查流程
        這些檢驗步驟環環相扣，每一個結果都需要被清楚、正確地記錄下來，才能確保後續醫療決策的正確性。更進一步來說，若這些資料能在病患轉診時，讓其他醫院快速理解，或是長期累積成資料庫，用來觀察整體抗生素抗藥性的變化趨勢，將能對病患以及社會帶來更大的幫助。
        要達成這些目標，統一資料格式就顯得格外重要。團隊以國際通用的 FHIR（Fast Healthcare Interoperability Resources）格式作為標準，並依循 CDM IG (Common Data Model Implementation Guide) 的設計規範來撰寫資料。CDM IG不僅符合台灣核心規範（TW Core IG），設計時也以檢驗檢查資料檔案為原型，更貼近醫院現有的常用格式。
        本範例提供模擬的抗生素抗藥性檢驗檢查報告、架構圖、JSON檔案以及常用病原體的SNOMED CT（Systematized Nomenclature of Medicine — Clinical Terms）代碼表。檢驗報告內容涵蓋顯微鏡檢查、細菌培養與鑑定，以及抗生素抗藥性檢測三大部分；架構圖幫助讀者理解檢驗資料轉換成 FHIR 格式的結構；驗證成功的 JSON 檔案，呈現最詳細、完整的資料內容；最後，SNOMED CT病原體代碼表完整包含了常見細菌，減少查找代碼的時間。所有範例皆經感染症專家與 FHIR 專家審核，將複雜的細菌與抗生素抗藥性資訊，以更清楚、易懂的方式呈現，為臨床醫療與研究應用打下良好的基礎。
最後更新時間：2026/2/13
參考資料：
台灣核心實作指引： https://twcore.mohw.gov.tw/ig/twcore/index.html
國家級人體生物資料庫整合平台共同資料模式實作指引：https://www.ghd.tw/cdm-fhir/index.html
NHS England Pathology FHIR Implementation Guide： https://simplifier.net/guide/pathology-fhir-implementation-guide/Home/FHIRAssets/AllAssets/All-Profiles/Examples/Bundles/Urine-MC-S-Report-Structured?version=0.1
HL7 Europe Laboratory Report： https://hl7.eu/fhir/laboratory/Bundle-BundleLabResultMicroCultureSusc.html#Observation_1097929f-890e-4e27-a31d-58599f3e2479 
此為模擬檢驗檢查的相關單張，目的為說明抗生素抗藥性檢驗檢查預期會進行的流程與結果。

此圖為簡化之資料架構示意圖，為使範例清楚易懂，僅呈現主要資源之間的核心關聯，未涵蓋所有關聯性。如需查閱各 Resource 之完整關聯與詳細定義，請參閱 Common Data Model Implementation Guide (IG)。此外，資料架構中之 Patient、Encounter、Specimen 與 Organization 等 Resource，該IG 已有完整說明與範例。為避免內容重複，本文不再另行列出，請依實際需求參考該 IG 進行調整與實作。

本範例撰寫感謝鄒小蕙老師、郭書辰醫師、楊奕馨老師、李修安博士、李麗惠老師與助理成捷共同協作。
  • {
    "resourceType": "Composition",
    "id": "com",
    "status": "final",
    "type": {
        "coding": [{
            "system": "https://www.ghd.tw/cdm-fhir/CodeSystem/ReportType",
            "code": "1",
            "display": "檢體檢驗報告"
        }]
    },
    "subject": {
        "reference": "Patient/pat-CDM"
    },
    "encounter": {
        "reference": "Encounter/enc-LABD"
    },
    "date": "2023-07-01T08:57:00+08:00",
    "author": [{
        "reference": "Organization/org-LABDM"
    }],
    "title": "檢驗檢查資料檔每日格式 LABD",
    "section": [{
        "code": {
            "coding": [{
                "system": "http://loinc.org",
                "code": "53903-1",
                "display": "Collection method - Specimen"
            }]
        },
        "entry": [{
            "reference": "Specimen/spe-LABDM"
        }]
    },
    {
        "code": {
            "coding": [{
                "system": "http://loinc.org",
                "code": "11502-2",
                "display": "Laboratory report"
            }]
        },
        "entry": [{
            "reference": "Observation/ms-pmn"
        },{
            "reference": "Observation/ms-ep"
        },{
            "reference": "Observation/ac-p"
        },{
            "reference": "Observation/detect"
        },{
            "reference": "Observation/count"
        },{
            "reference": "Observation/sus"
        },{
            "reference": "DiagnosticReport/DR-gs"
        },{
            "reference": "DiagnosticReport/DR-ac"
        }]
    }]
}
    

  • {
    "resourceType": "DiagnosticReport",
    "id":"diag-LABDM-DR-gs",
    "status":"final",
    "category": [{
        "coding": [{
            "system": "http://terminology.hl7.org/CodeSystem/v2-0074",
            "code": "LAB",
            "display": "Laboratory"
        }],
        "text": "Laboratory"
    }],
    "code": {
        "coding": [{
            "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/laboratory-category-tw",
            "code": "13006C",
            "display": "排泄物,滲出物及分泌物之細菌顯微鏡檢查"
        }],
        "text": "顯微鏡檢查(使用革蘭氏染色)"
    },
    "subject": {
        "reference": "Patient/pat-CDM"
    },
    "result": [{
        "reference": "Observation/obs-LABDM-ms-pmn"
    },{
        "reference": "Observation/obs-LABDM-ms-ep"
    }],
    "conclusion": "0"
}
  • {
    "resourceType": "Observation",
    "id": "obs-LABDM-ms-pmn",
    "identifier": [{
        "value": "1"
    }],
    "status": "final",
    "category": [{
        "coding": [{
            "system": "http://terminology.hl5.org/CodeSystem/observation-category",
            "code": "laboratory"
        }]
    }],
    "code": {
        "coding": [{
            "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/laboratory-category-tw",
            "code": "13006C"
        },{
            "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/loinc-observation-code",
            "code": "72163-9",
            "display": "Leukocytes [Presence] in Specimen by Gram stain"
        }],
        "text":"痰液中的Leukocyte是檢查polymorphonuclear cell，未來若有更適合的代碼會再修改" 
    },
    "subject": {
        "reference": "Patient/pat-CDM"
    },
    "encounter": {
        "reference": "Encounter/enc-LABD"
    },
    "effectiveDateTime": "2023-07-01T08:57:00+08:01",
    "method": {
        "coding": [{
            "system": "http://snomed.info/sct",
            "code": "708061008"
        }],
        "text": "Gram stain"
    },
    "valueString": ">25/100X",
    "referenceRange": [{
        "text": "無資料"
    }]
}
  • 痰液中的Leukocyte是檢查polymorphonuclear cell。現行 LOINC 尚無對應之代碼，暫採「Leukocytes [Presence] in Specimen by Gram stain」。待後續釋出更合適之標準代碼時，將依標準更新。
  • {
    "resourceType": "Observation",
    "id": "obs-LABDM-ms-ep",
    "identifier": [{
        "value": "1"
    }],
    "status": "final",
    "category": [{
        "coding": [{
            "system": "http://terminology.hl5.org/CodeSystem/observation-category",
            "code": "laboratory"
        }]
    }],
    "code": {
        "coding": [{
            "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/laboratory-category-tw",
            "code": "13006C"
        },{
            "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/loinc-observation-code",
            "code": "72161-3",
            "display": "Epithelial cells [Presence] in Specimen by Gram stain"
        }],
        "text": "檢查EPITHELIUM"
    },
    "subject": {
        "reference": "Patient/pat-CDM"
    },
    "encounter": {
        "reference": "Encounter/enc-LABD"
    },
    "effectiveDateTime": "2023-07-01T08:57:00+08:01",
    "method": {
        "coding": [{
            "system": "http://snomed.info/sct",
            "code": "708061008"
        }],
        "text": "Gram stain"
    },
    "valueString": "10-25/100x",
    "referenceRange": [{
        "text":"無資料"
    }]
}
  • {
    "resourceType": "DiagnosticReport",
    "id": "diag-LABDM-DR-ac",
    "status": "final",
    "category": [{
        "coding": [{
            "system": "http://terminology.hl7.org/CodeSystem/v2-0074",
            "code": "LAB",
            "display": "Laboratory"
        }],
        "text": "Laboratory"
    }],
    "code": {
        "coding": [{
            "system": "http://loinc.org",
            "code": "11502-2",
            "display": "Laboratory report"
        }],
        "text": "細菌培養鑑定與抗生素抗藥性檢查"
    },
    "subject": {
        "reference": "Patient/pat-CDM"
    },
    "result": [{
        "reference": "Observation/obs-LABDM-ac-p"
    },{
        "reference": "Observation/obs-LABDM-detect"
    },{
        "reference": "Observation/obs-LABDM-count"
    },{
        "reference": "Observation/obs-LABDM-sus"
    }],
    "conclusion": "0"
}
  • {
    "resourceType": "Observation",
    "id": "obs-LABDM-detect",
    "identifier": [{
        "value": "1"
    }],
    "status": "final",
    "category": [{
        "coding": [{
            "system": "http://terminology.hl5.org/CodeSystem/observation-category",
            "code": "laboratory"
        }]
    }],
    "code": {
        "coding": [{
            "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/laboratory-category-tw",
            "code": "13007C"
        },{
            "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/loinc-observation-code",
            "code": "6463-4",
            "display": "Bacteria identified in Specimen by Culture"
        }],
        "text": "細菌鑑定(有氧培養)"
    },
    "subject": {
        "reference": "Patient/pat-CDM"
    },
    "encounter": {
        "reference": "Encounter/enc-LABD"
    },
    "effectiveDateTime": "2023-07-01T08:57:00+08:01",
    "method": {
        "coding": [{
            "system": "http://snomed.info/sct",
            "code": "7882003",
            "display": "Identified (qualifier value)"
        }],
        "text": "細菌鑑定"
    },
    "valueCodeableConcept": {
        "coding": [{
            "system": "http://snomed.info/sct",
            "code": "91288006",
            "display": "Acinetobacter baumannii (organism)"
        }],
        "text": "Acinetobacter baumannii"
    },
    "referenceRange": [{
        "text": "無資料"
    }]
}
  • {
    "resourceType": "Observation",
    "id": "obs-LABDM-ac-p",
    "identifier": [{
        "value": "1"
    }],
    "status": "final",
    "category": [{
        "coding": [{
            "system": "http://terminology.hl5.org/CodeSystem/observation-category",
            "code": "laboratory"
        }]
    }],
    "code": {
        "coding": [{
            "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/laboratory-category-tw",
            "code": "13007C"
        },{
            "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/loinc-observation-code",
            "code": "LP6103-8",
            "display":"Aerobic Culture"
        }],
        "text": "有氧培養，待LOINC更新有適合的代碼時，將修改代碼"
    },
    "subject": {
        "reference": "Patient/pat-CDM"
    },
    "encounter": {
        "reference": "Encounter/enc-LABD"
    },
    "effectiveDateTime": "2023-07-01T08:57:00+08:01",
    "method": {
        "coding": [{
            "system": "http://snomed.info/sct",
            "code": "703750006",
            "display": "Aerobic Culture"
        }],
        "text": "有氧培養"
    },
    "valueCodeableConcept": {
        "coding": [{
            "system": "http://snomed.info/sct",
            "code": "10828004",
            "display": "Positive"
        }],
        "text": "Aerobic culture positive"
    },
    "referenceRange": [{
        "text": "無資料"
    }]
}
  • 本檔目前暫以LOINC Part code標示「有氧培養（Aerobic Culture）」。待 LOINC 更新並提供適用之標準代碼後，將依標準進行代碼調整與更新。
  • {
    "resourceType": "Observation",
    "id": "obs-LABDM-count",
    "identifier": [{
        "value": "1"
    }],
    "status": "final",
    "category": [{
        "coding": [{
            "system": "http://terminology.hl5.org/CodeSystem/observation-category",
            "code": "laboratory"
        }]
    }],
    "code": {
        "coding": [{
            "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/laboratory-category-tw",
            "code": "13007C"
        },{
            "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/loinc-observation-code",
            "code": "LP16817-6",
            "display": "Colony count"
        }],
        "text": "菌落計數"
    },
    "subject": {
        "reference": "Patient/pat-CDM"
    },
    "encounter": {
        "reference": "Encounter/enc-LABD"
    },
    "effectiveDateTime": "2023-07-01T08:57:00+08:00",
    "method": {
        "coding": [{
            "system": "http://snomed.info/sct",
            "code": "118022004",
            "display": "Colony count (procedure)"
        }],
        "text": "菌落計數"
    },
    "valueCodeableConcept": {
        "coding": [{
            "system": "http://snomed.info/sct",
            "code": "1255665007",
            "display": "Moderate"
        }],
        "text": "MODERATE"
    },
    "referenceRange": [{
        "text": "無資料"
    }]
}
  • {
    "resourceType": "Observation",
    "id": "obs-LABDM-sus",
    "identifier": [{
        "value": "1"
    }],
    "status": "final",
    "category": [{
        "coding": [{
            "system": "http://terminology.hl5.org/CodeSystem/observation-category",
            "code": "laboratory"
        }]
    }],
    "code": {
        "coding": [{
            "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/laboratory-category-tw",
            "code": "13023C"
        },{
            "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/loinc-observation-code",
            "code": "29576-6",
            "display": "Bacterial susceptibility panel "
        }],
        "text": "藥物敏感性試驗"
    },
    "subject": {
        "reference": "Patient/pat-CDM"
    },
    "encounter": {
        "reference": "Encounter/enc-LABD"
    },
    "effectiveDateTime": "2023-07-01T08:57:00+08:01",
    "method": {
        "coding": [{
            "system": "http://snomed.info/sct",
            "code": "708073008",
            "display": "Minimum inhibitory concentration susceptibility test"
        }],
        "text": "細菌最低抑制濃度快速試驗"
    },
    "component": [{
        "code": {
            "coding": [{
                "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/loinc-observation-code",
                "code": "28-1",
                "display": "Ampicillin [Susceptibility] by Minimum inhibitory concentration (MIC)"
            }]
        },
        "valueQuantity": {
            "value": 32,
            "comparator": ">="
        },
        "interpretation": [{
            "coding": [{
                "system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
                "code": "R",
                "display": "Resistant"
            }],
            "text": "RESISTANT"
        }]
    },{
        "code": {
            "coding": [{
                "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/loinc-observation-code",
                "code": "76-0",
                "display": "ceFAZolin [Susceptibility] by Minimum inhibitory concentration (MIC)"
            }]
        },
        "valueQuantity": {
            "value": 64,
            "comparator": ">="
        },
        "interpretation": [{
            "coding": [{
                "system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
                "code": "R",
                "display": "Resistant"
            }],
            "text": "RESISTANT"
        }]
    },{
        "code": {
            "coding": [{
                "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/loinc-observation-code",
                "code": "267-5",
                "display": "Gentamicin [Susceptibility] by Minimum inhibitory concentration (MIC)"
            }]
        },
        "valueQuantity": {
            "value": 8
        },
        "interpretation": [{
            "coding": [{
                "system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
                "code": "I",
                "display": "Intermediate"
            }],
            "text": "INTERMEDIATE"
        }]
    },{
        "code": {
            "coding": [{
                "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/loinc-observation-code",
                "code": "12-5",
                "display": "Amikacin [Susceptibility] by Minimum inhibitory concentration (MIC)"
            }]
        },
        "valueQuantity": {
            "value": 2,
            "comparator": "<="
        },
        "interpretation": [{
            "coding": [{
                "system": "https://twcore.mohw.gov.tw/ig/twcore/ValueSet/loinc-observation-code",
                "code": "S",
                "display": "Susceptible"
            }],
            "text": "SUSCEPTIBLE"
        }]
    }],
    "referenceRange": [{
        "text": "無資料"
    }]
}
SNOMED CT版本: SnomedCT_InternationalRF2_PRODUCTION_20250701T120000Z
美國病理學會(CAP)版本: 2023
該對照表僅供參考，若有疑問請詢問相關專家。
 

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