Methicillin抗藥性金黃色葡萄球菌菌血症的臨床表現與微生物學特徵：48個個案分析

Clinical Manifestations and Microbiological Characteristics of Methicillin-resistant Staphylococcus aureus in Bacteremic Patients: Analysis of Forty Eight Cases

陳昶華(Chang-Hua Chen) ； 林麗珍(Li-Chen Lin) ； 廖淑真(Shu-Chen Liao) ； 陳昱旻(Yu-Min Chen) ； 張玉君(Yu-Jun Chang) ； 劉尊榮(Chun-Eng Liu) ； 楊祖光(Tzuu-Guang Young)

《The Changhua Journal of Medicine》 7卷3期 (2002/07) Pp. 147-153

摘要

背景及目的：觀察Methicillin抗藥性金黃色葡萄球菌菌血症病患的臨床表現，與篩檢萬古黴素抗藥性金黃色葡萄球菌。
方法：自民國88年7月1日至民國89年6月30日止，針對彰化基督教醫院Methicillln抗藥性金黃色葡萄球菌(methicillin-resistant Stphylococcus aureus)菌血症的病患進行前瞻性的研究，分析病患的臨床表現，並且進行萬古黴素抗藥性金黃色葡萄球菌的篩檢。以Pearson x^2等統計方法分析。
結果：在48位病患，男性20位，女性28位。年齡分布於2歲與87歲之間，平均年齡為63.2歲(63.2±22.3)，發現MRSA菌血症在本院的發生率為十萬分之92人次。MRSA菌血症死亡率為37.5% (18/48)。MRSA菌落大小(P=0.61)、紙錠擴散試驗的抑菌環直徑(P=0.83)、及E-test萬古黴素最低抑菌濃度(P=1.0)，與臨床預後並無明顯的統計相關性。
結論：目前本院沒有萬古黴素抗藥性金黃色葡萄球菌。MRSA菌血症個案的嚴重性是值得重視的。

關鍵字

菌血症 ； Methicillin抗藥性金黃色葡萄球菌 ； 萬古黴素抗藥性金黃色葡萄球菌

並列摘要

Background and purpose: We focused on the analysis of patients afflicted with methicillin-resistant Staphylococcus aureus (MRSA). We examined clinical presentations in these patients and the microbiological characteristics of Staphylococcus aureus isolates. In addition, we screened specimens for the presence of vancomycin-resistant Staphylococcus aureus.
Methods: We studied a cohort of 48 MRSA bacteremic patients seen at CCH during the period from July 1, 1999 to June 30, 2000. We collected all clinical and microbiological data, and used the Student's test, Pearson x^2 test, Mantel-Haenszel's test and Fisher's exact test for statistical analysis.
Results: Forty-eight patients were analyzed. Twenty patients were male, and 28 were female. Female to male ratio was 1.4. The mean age was 63.2 years. The incidence of MRSA bacteremia was 0.092%. The mortality rate was 37.5% (18/48). We reexamined MRSA strains by methods as suggested by NCCLS, and found that the clinical outcome falis to correlate with the colony size (P=0.61), the size of inhibition zone (P=0.83), and the B-test results (P=1.0). We did not identify any vancomycin-resistant Staphylococcus aureus strains during this period.
Conclusion: As we failed to identify any vancomycin-resistant Staphylococcus aureus strains, it is logic for us to focus only on problems in patients who were bacteremic with methicillin-resistant Staphylococcus aureus in future studies.

並列關鍵字

bacteremia ； methicillin-resistant Staphylococcus aureus ； vancomycin-resistant Staphylococcus aureus