Colonization with Vancomycin-Resistant Enterococcus and Oxacillin-resistant Staphylococcus Aureus in Critically Ill Cirrhotic Patients

重症肝硬化病人合併抗藥性腸球菌及金黃色葡萄球菌移生的臨床特徵及預測因子

黃欣智(Hsin-Chih Huang) ； 陳永昌(Yung-Chang Chen) ； 彭雲杏(Yun-Shing Peng) ； 田亞中(Ya-Chung Tian) ； 連昭明(Jau-Min Lien) ； 陳邦基(Pang-Chi Chen) ； 方基存(Ji-Tseng Fang) ； 楊智偉(Chih-Wei Yang) ； 吳正雄(Cheng-Shyong Wu) ； 蔡銘鴻(Ming-Hung Tsai)

《臺灣消化醫學雜誌》 29卷4期 (2012/12) Pp. 334-341

https://doi.org/10.6557/GJT.201212_29(4).0003

摘要

背景及目標：在重症肝硬化患者身上，抗藥性腸球菌的發生愈來愈普遍。然而相關資料並不完備。方法：我們回溯性研究238位重症肝硬化入住加護病房的各項臨床資料，分析與抗藥性腸球菌相關的各式因子。結果：百分之6.72的肝硬化病人在入住加護病房時已帶有VRE或ORSA，帶有抗藥株的肝硬化病人有較高比例同時患有COPD，及曾使用過metronidazole及glycopeptide類的抗生素，另外住院天數也較未帶有抗藥株的病人長。死亡率則兩組沒有差別。曾使用過metronidazole是與VRE及ORSA相關的獨立因子。結論：VRE, ORSA帶菌在重症肝硬化病人並不少見。我們需要前瞻性研究，分析各式危險因子並藉以制定防範措施。

關鍵字

肝硬化 ； 重症加護病房 ； 抗藥性金黃色葡萄球菌 ； 抗藥性腸球菌

並列摘要

Background and Aims: The occurrence of colonization with antibiotic-resistant Gram-positive cocci becomes more and more common among cirrhotic patients requiring intensive care. Few data is available about the prevalence and risk factors of colonization with vancomycin-resistant entercoccus (VRE) or oxacillin-resistant staphylococcus aureus (ORSA) in critically cirrhotic patients.Methods: We retrospectively analyzed the prevalence of ORSA and VRE carriage in 238 cirrhotic patients at admission to ICU and analyze factors associated with ORSA and VRE carriage.Results: Sixteen out of 238 patients (6.72%) were already colonized with either ORSA or VRE upon admission to ICU. Compared to non-colonized patients, the colonized patients were more likely to have chronic obstructive pulmonary disease (P=0.003) or to have received metronidazole (P=0.003) and glycopeptide antibiotics (vancomycin, teicoplanin) (P=0.010). The ICU and hospital stays were significantly longer in those patients with colonization with VRE or ORSA. However, there was no difference in mortality rates. Administration of metronidazole before admission to ICU was an independent factor associated with colonization with VRE or ORSA.Conclusions: Colonization with VRE or ORSA is common in critically ill cirrhotic patients upon admission to ICU. Prospective studies with surveillance cultures are needed to address potential risk factors and help develop strategies for prevention of colonization in critically ill cirrhotic patients.

並列關鍵字

liver cirrhosis ； Intensive Care Unit ； oxacillin-resistant staphylococcus aureus ； vancomycin-resistant enterococcus