南部某一醫學中心多重抗藥性Acineto-bacter baumannii院內菌血症感染之臨床分析

Nosocomial Bloodstream Infections Due to multidrug-resistant Acinetobacter baumannii at a Medical Center in Southern Taiwan

李南瑶(Nan-Yao Lee) ； 李欣純(Hsin-Chun Lee) ； 劉恭宏(Kung-Hung Liu) ； 張科(Ko Chang) ； 黃紹宗(Sau-Zon Hung) ； 柯文謙(Wen-Chien Ko)

《感染控制雜誌》 13卷5期 (2003/10) Pp. 266-274

https://doi.org/10.6526/ICJ.200310_13(5).0001

摘要

近年來多重抗藥性Acinetobacter baumannii院內感染已日益嚴重，特別是在重症或具有嚴重潛在性疾病的患者。此一回溯性研究的目的是在瞭解其造成菌血症之潛在因素及相關危險因子，及評估因多重抗藥性A. baumannii所造成之院內感染菌血症之臨床預後。在回溯研究期間共有46位多重抗藥性A. baumannii院內感染菌血症患者，其平均年齡爲61歲，從住院到發生菌血症期間約爲18日。惡性腫瘤(39.1%)和糖尿病(37%)爲最常見之潛在性疾病。原發性菌血症(50%)、肺炎(43.5%)及導管相關性感染(2.2%)爲常見造成菌血症之原因。頭孢子黴素(cephalosporin)類抗生素是菌血症前最常使用之抗生素(69.6%)，菌血症前平均抗生素使用時間爲13.4天。22位患者於住院中死亡，粗死亡率(crude mortality)爲47.8%。患者併有嚴重感染症(p=0.03)、敗血性休克(p=0.002)、急性腎衰竭(p=0.001)或血液凝固病變(p=0.005)者有較差之預後。在菌血症發生5天內使用適當的抗生素治療者預後較佳。多重抗藥性A. baumannii菌血症常合併有較高之死亡率。疾病嚴重性、敗血性休克、急性腎衰竭或血液凝固病變爲死亡相關之危險因子，適當的抗生素治療能有效降低死亡率。

關鍵字

多重抗藥性 multi-drug resistant ； Acinetobacter baumannii ； 菌血症 bacteremia

並列摘要

The upsurge of nosocomial infections due to multidrug-resistant Acinetobacter baumannii (MDRAB) was noted, particular in critically ill patients and those with significant underlying disease. The aim of this retrospective study was to determine the predisposing conditions, risk factors, and clinical outcome of nosocomial bacteremia cased by MDRAB isolates. Forty-six patients with nosocomial MDRAB bloodstream infection were identified. Their mean age was 61 years. Mean duration from admission to the onset of bacteremia was 18 days. Diabetes mellitus (36.9%) and malignancy (39.1%) were the most common underlying diseases. Primary bacteremia (50%), pneumonia (43.5%), and catheter-related infection (2.2%) were the portals of entry. Cephalosporins were the most common exposed antimicrobial agents, and the mean duration of previous antibiotics exposure was 13.4 days. Twenty-two of 46 patients died during hospitalization. The crude mortality rate was 47.8% and attributable mortality 28.3%. Severe illness at the onset of bacteremia (P=0.03), presence of septic shock (P=0.002), acute renal failure (P=0.001) and coagulopathy (P=0.005), heralded a poor prognosis. Use of appropriate antimicrobial agents, i.e. carbapenem, within 5 days after the onset of bacteremia, was associated with a better outcome (P=0.02). Therefore, MDRAB bloodstream infection was associated with a high mortality. Severe illness, septic shock, acute renal failure and coagulopathy are associated with a grave outcome, and due and appropriate antimicrobial therapy may reduce the risk of fatality.

並列關鍵字

multidrug-resistant ； Acinetobacter baumannii ； bacteremia