Nosocomial Acinetobacter Baumannii Bacteremia: Comparison of the Clinical Manifestations of Multiresistant Strain and Non-multiresistant Strain Infections

院內感染性包氏不動桿菌菌血症：比較多重抗藥性菌株與非多重抗藥性菌株的臨床表現

陳昶華(Chang-Hua Chen) ； 林麗珍(Li-Chen Lin) ； 黃凱琳(Kai-Lin Hwang)

《The Changhua Journal of Medicine》 7卷2期 (2002/04) Pp. 86-92

摘要

本研究主要目的是比較抗藥性與非抗藥性包氏不動桿菌(Acinetobacte baumannii)引起的臨床症狀。民國87年1月l日到88年4月30日間總共收集23例院內感染包氏不動桿菌菌血症病患，其中13株包氏不動桿菌是屬於多重抗藥性菌株。院內感染包氏不動桿菌菌血症的發生率(incidence)是每一萬住院病患會有4.34例。全部23病例當中男女比例為1.3。平均年紀為60.7歲（1到81歲）。依照 McCabe與Jackson分類標準，有15位病患屬於死亡與極快速死亡這兩組。17位病患需要住進加護病房。主要的致病危險因子為：使用導管、先前使用過抗生素、與先前使用過呼吸器。在發病當日，21位病患發燒，2位病患休克。呼吸道感染是最常見的感染來源。院內感染包氏不動桿菌菌血症死亡率為56% (13/23)。比較抗藥性與非抗藥性包氏不動桿菌引起的臨床症狀，發現兩組在臨床表現、危險因子等等均沒有明顯的差異，只有抗藥性包氏不動桿菌引起的死亡率比非抗藥性包氏不動桿菌高(76.9% vs. 30%, P=0.04)。早期診斷對於早期治療是很重要的。開發出快期診斷的技術在診斷包氏不動桿菌感染是有需要的。

關鍵字

包氏不動桿菌 ； 菌血症 ； 抗藥性菌株 ； 院內感染

並列摘要

The purpose of this study was to compare clinical manifestations of infections caused by the multiresistant strain of Acinetobacter baumannii with that caused by the non-multiresistant strain. A total of 23 patients with nosocomial A.. baumannii bacteremia treated between January 1, 1998 and April 30, 1999 were included in the study; 13 were infected with the multiresistant strain. The overall incidence of nosocomial A. baumannii bacteremia was 4.34 per 10,000 admissions. The male to female ratio was 1.3. The mean age of patients was 60.7 years old (range: 1-8 1). Fifteen patients belonged to the fatal and ultimately fatal group by the McCabe and Jackson criteria, and 17 patients required hospital stay in the intensive care unit. The main risk factors included catheter usage, previous antibiotic usage, and prior ventilator usage. Twenty-one patients had fever and two had shock at the onset of nosocomial A. baumannii bacteremia. Respiratory tract infection was the most common source of infection. The mortality rate of nosocomial A. baumannii bacteremia was 56.5% (13/23). When the clinical manifestations of patients infected with the multiresistant strain were compared to those of patients infected by the non-multiresistant strain of A. baumannii, no significant difference in the risk factors and clinical presentations could be discerned between these two groups. Nosocomial acquisition of the multiresistant A. baumannii strain was associated with excess mortality (76.9% vs. 30%, P=0.04). Early detection of multiresistant A. baumannii is important in making early and correct treatment. The development of a new diagnostic technique is needed to confront the problem of troublesome A. baumannii infection.

並列關鍵字

Acinetobacter baumannii ； bacteremia:multiresistant strain ； nosocomial