The Outcome of Healthcare-Associated Pseudomonas Aeruginosa Infection in Chronically Ventilated Patients in a Tertiary Care Hospital in Taiwan

台灣地區醫院慢性呼吸器使用病人醫療照護相關－綠膿桿菌感染之結果研究

陳冠元(Guan-Yuan Chen) ； 林鴻銓(Horng-Chyuan Lin) ； 鍾福財(Fu-Tsai Chung) ； 謝孟亨(Meng-Heng Hsieh) ； 枋岳甫(Yueh-Fu Fang) ； 余志騰(Chih-Teng Yu) ； 郭漢彬(Han-Pin Kuo)

《重症醫學雜誌》 12卷4期 (2011/12) Pp. 147-157

https://doi.org/10.30035/TCCM.201112.0001

摘要

前言：過去有關於醫療照護相關－綠膿桿菌感染的研究大多數集中在急性呼吸衰竭併使用呼吸器的病人，而較少有對於慢性呼吸器使用的病人醫療照護相關－綠膿桿菌感染發生率及其結果之研究。本篇回溯性研究旨在針對慢性呼吸器使用病人其醫療照護相關－綠膿桿菌感染的情況同時探討哪些因子會影響因醫療照護相關－綠膿桿菌感染而進入急性加護病房之病人的結果。方法：本文從2002至2006年總共收集了179位慢性呼吸器使用的病人其中有66位發生醫療照護相關－綠膿桿菌感染。研究中分析了這些病人的特性及探討因醫療照護相關－綠膿桿菌感染而需住急性加護病房之病人的死亡預測因子。結果：病人平均呼吸器使用天數為206天。24位（36.4%）因醫療照護相關－綠膿桿菌感染需急性加護病房照護而其中有14位（58.3%）死亡。將可能影響死亡的因子先由雙變數統計分析篩選後，再利用經年齡及性別調整過的多變數統計分析方式，發現APACHEII分數（調整後的勝算比為5.23；95%信心區間為1.07至2.28；p值為0.02），休克存在與否（調整後的勝算比為4.58；95%信心區間為1.21至2.68；p值為0.03），以及開始接受適當抗生素使用的時間（調整後的勝算比為3.82；95% 信心區間為1.01至2.81；p值為0.05）為預測因醫療照護相關－綠膿桿菌感染而需急性加護病房照護的病人死亡的獨立因子。結論：醫療照護相關－綠膿桿菌感染在慢性呼吸器使用病人不僅發生率增加同時對於因此而需急性加護病房照護及死亡也很重要。APACHEII分數，休克存在與否，開死接受適當抗生素使用的時間為影響死亡與否的獨立因子。延遲治療可能會造成較高的死亡率而適時的使用抗生素對於改善感染造成的結果很重要。

關鍵字

醫療照護相關－綠膿桿菌感染 ； 慢性呼吸器使用 ； 感染結果 ； 長期呼吸器使用 ； 不適當之抗生素治療

並列摘要

Introduction: Most studies related to healthcare-associated infection with Pseudomonas aeruginosa (HAI-PA) are on acutely ventilated patients. Little is known regarding the incidence and outcomes of HAI-PA in chronically ventilated patients. This retrospective study aimed to study HAI-PA in chronically ventilated patients and the factors that affect outcome in those requiring intensive care unit (ICU) admission.Patients and Method: From 2002 to 2006, a total of 179 chronically ventilated patients and 66 patients with HAI-PA were enrolled in the study for analysis of patients' characteristics and factors that predict ICU mortality when these subjects need ICU admission.Results: The median ventilated duration of all chronically ventilated patients was 206 days. Twenty four (36.4%) patients with HAI-PA needed ICU admission and 14 (58.3%) died. By multivariate analysis adjusted by age and gender after selection by bivariate analysis, APACHE II score (adjusted odds ratio, 5.23; 95% CI, 1.07 to 2.28; p=0.02), the presence of shock (adjusted odds ratio, 4.58; 95% CI, 1.21 to 2.68; p=0.03), and time to receive appropriate antibiotics (adjusted odds ratio, 3.82, 95% CI,1.01 to 2.81; p=0.05) were independent factors that predict ICU mortality of patients with HAI-PA requiring ICU admission.Conclusions: HAI-PA is not only increasing in chronic ventilated patients and but also important to their ICU admission and mortality. APACHE II scores, the presence of shock, and the time to receive appropriate antibiotics are the independent factors of mortality. Delayed treatment may cause a higher mortality and proper antibiotic treatment is important to improve outcome.

並列關鍵字

Healthcare-associated infection with Pseudomonas aeruginosa (HAIPA) ； Chronic ventilation ； Outcome ； Prolonged ventilation ； Inappropriate antibiotics treatment