Evaluation of Outcome in Elderly Critically Ill Patients with Nosocomial Klebsiella Pneumoniae Bacteremia

老年重症患者合併克雷白氏肺炎桿菌菌血症之預後探討

張孫貽(Sun-Yie Chang) ； 連德正(Te-Cheng Lien) ； 王家弘(Jia-Horng Wang)

《胸腔醫學》 20卷1期 (2005/02) Pp. 25-32

https://doi.org/10.29806/TM.200502.0004

摘要

背景：在加護病房中一般認為合併革蘭氏陰性菌菌血症對於額外增加死亡率並不明顯，不過這在老年患者並不一定如此。
目的：探討老年重症患者合併院內感染克雷白氏肺炎桿菌菌血症之預後以及克雷白氏肺炎桿菌菌血症在相同疾病嚴重度的老人患者是否有更高的死亡率。
設計：回溯性配對性研究。
場所：台北榮總之三十床內科加護病房。
對象：31位年齡超過65歲的內科重症患者合併克雷白氏肺炎桿菌菌血症以及62位的對照組患者。
方法：以1:2比例配置對照組病患主要是基於APACHEII分數以及年齡。從這個疾病嚴重度分類系統我們可以得到預期死亡率；若無其他因素影響，經由此配對方法所得到的預期死亡率在實驗組與對照組應該是相同的。
結果：老年重症患者合併克雷白氏肺炎桿菌菌血症比起對照組有明顯較高的死亡率(61.3%vs261%，p=0.003)以及血小板低下症(51.6%vs26.1%，p=0.034)。在相同疾病嚴重度的患者，合併克雷白氏肺炎桿菌菌血症所額外增加的死亡率高達35.2%。而加護病房的住院天數(33.48days vs. 32.69days，p=0.858)及呼吸器使用天數(31.90days vs. 29.01days，p=0.434)，兩者則無明顯差異。
結論：在考量病患的疾病嚴重度之下，合併克雷白氏肺炎桿菌菌血症的老年患者確實有較高的死亡率。

關鍵字

老年 ； 克雷白氏肺炎桿菌 ； 菌血症

並列摘要

Background: Gram-negative bacteremia is considered to have little impact on mortality in ICU patients. However, this may not be true in elderly patients.
Objective: To determine outcome and attributable mortality in elderly critically ill patients with nosocomial bacteremia involving Klebsiella pneumoniae.
Design: A retrospective matched cohort study.
Setting: Thirty-bed medical ICU at Taipei Veterans General Hospital.
Patients: Thirty-one medical ICU patients aged more than 65 years old with K. pneumoniae bacteremia and 62 matched control patients.
Methods: The matching of the control patients (1:2 ratio) was done on the basis of the APACHE II score and age. Without the impact of K. pneumoniae bacteremia, this matching procedure was expected to result in a similar mortality rate for the 2 groups.
Results: Elderly patients with K. pneumoniae bacteremia had a significantly higher mortality rate (61.3% vs 26.1%, p=0.003) and more thrombocytopenia (51.6% vs 26.1%, p=0.034) than the control group. Attributable mortality was 35.2%. There was no significant difference in length of ICU stay (33.48 days vs. 32.69 days, p=0.858) and number of ventilator days (31.90 days vs. 29.01 days, p=0.434) between the two groups.
Conclusions: After adjusting for severity of disease, Klebsiella pneumoniae bacteremia had significantly increased mortality among the elderly patients.

並列關鍵字

elderly ； Klebsiella pneumoniae ； bacteremia