以改良早期預警評分、快速連續性器官衰竭評估及共病測量指數評估成年住院病人感染碳青黴烯無效之鮑氏不動桿菌或綠膿桿菌不適當抗生素治療之預後

Prognosis of Hospitalized Adults with Inappropriate Antibiotic Therapies for Carbapenem-nonsusceptible Acinetobacter baumanii or Pseudomonas aeruginosa Infections Measured by Modified Early Warning Score, quick Sepsis related Organ Failure Assessment and Charlson Comorbidity Index

蔡孟憲(Moan-Shane Tsai) ； 楊慈玲(Tzu-Ling Yang) ； 張喬棠(Chiao-Tang Chang)

《秀傳醫學雜誌》 預刊文章 Pp. 1-22

https://doi.org/10.30185/SCMJ.202303/PP.0035

摘要

為瞭解碳青黴烯無感受性之綠膿桿菌（CRPA）及鮑氏不動桿菌（CRAB）感染之住院成年人接受不適當抗生素治療的預後。從2016年1月至2017年6月回溯性分析阮綜合醫院CRPA及CRAB感染成年病患之資料。計算改良早期預警評分（Modified Early Warning Score）、快速連續性器官衰竭評估（quick Sepsis related Organ Failure Assessment）及共病測量指數（Charlson Comorbidity Index）。比較CRPA及CRAB細菌感染之病人存活者的各臨床指標分數差異，以求分數高低對病患預後之影響。共有76筆不重複資料是CRAB及CRPA感染者接受不適當抗生素治療病患；57位是CRAB感染者（平均年齡70.9歲，四分位數間距（IQR）64.6-79.5歲；19位是CRPA感染者（平均年齡71.9歲，IQR 60.4-82.8歲）。檢體的來源多是呼吸道分泌物（佔81.6%）。CRPA及CRAB感染病患的死亡率分別是31.6及38.6%。改良早期預警評分六分以上之CRAB感染者相較於分數較低之感染者其存活率較低，且在統計學上有顯著差異。臨床上可以藉改良早期預警評分得分多寡預測CRAB住院感染者之預後。

關鍵字

碳青黴烯感受性細菌 ； 改良早期預警評分 ； 快速連續性器官衰竭評估 ； 共病測量指數 ； 預後

並列摘要

To predict the prognosis of hospitalized adults with carbapenem-nonsusceptible Acinetobacter baumani (CRAB) or Pseudomonas aeruginosa (CRPA) infections undergoing inappropriate antibiotic therapies. Between January 1, 2016 and June 30, 2017, medical records of consecutive hospitalized adults at Yuan's General Hospital were retrospectively reviewed, from which Modified Early Warning Score (MEWS), quick Sepsis related Organ Failure Assessment (qSOFA), and Charlson Comorbidity Index (CCI) of each patient were calculated. The survival rates of patients with CRPA and CRAB infections stratified by MEWS, qSOFA and CCI scores were compared. A total of 76 non-duplicate subjects with CRAB or CRPA infections were identified; 57 patients were of CRAB infections (average age 70.9 years, interquantile range [IQR] 64.6 - 79.5 years); 19 of CRPA infections (71.9 years, IQR 60.4 - 82.8 years). Most of CRPA and CRAB were yielded from respiratory tract secretions samples (81.6%). The mortality rates for patients of CRPA vs. CRAB infections were 31.6 vs. 38.6%, respectively. Patients with CRAB infections of MEWS score ≥ 6 exhibited statistically significant lower survival rate than those of ≤ 1. Patients with CRAB infections of MEWS score ≥ 6 predicted grave prognosis compared to those of ≤1. MEWS measurement offers a prognostic evaluation in the setting of hospitalized patients with CRAB infections.

並列關鍵字

Prognosis ； Carbapenem-resistant ； Modified Early Warning Score ； Quick Sepsis related Organ Failure Assessment ； Charlson Comorbidity Index