The Incidence, Associated Risk and Mortality Factors of Patients with Bacteremia Attending an Emergency Department

急診室菌血症病患之發生率、危險及死亡相關因子

許文祥(Boon-Siang Khor) ； 藍秉文(Ping-Man Lam) ； 陳世雄(Shih-Hsiung Chen) ； 廖浩欽(How-Chin Liao) ； 廖訓禎(Shiumn-Jen Liaw) ； 黃忠智(Chung-Chih Huang)

《台灣急診專科醫師期刊》 1卷1期 (2009/12) Pp. 1-10

https://doi.org/10.29749/JTCEP.200912.0001

摘要

目的：探討急診患者菌血症之發生率、危險及死亡相關因子。
方法：研究設計以教學醫院為基礎之回顧性分析；時間自2005年1月至2006年12月，對象為所有至急診求診之菌血症患者。
結果：研究對象為701位病患（男性307位，女性394位），平均年齡65.5±17.5歲。粗估發生率為0.6%。最常見的臨床表現及診斷分別為敗血症(52.4%)和泌尿道感染(36.4%)；而最常的致病菌是大腸桿菌(39.2%)。臨床上，菌血症病患具有較嚴重的臨床表現及較高的住院率。在多重變項統計分析下，具臨床統計意義之罹患菌血症危險相關因子包括年齡≧65歲、高血壓、腦血管疾病、慢性阻塞性肺部疾病、腎衰竭、貧血和帶狀白血球增多症。罹患菌血症之死亡率統計上明顯高於非菌血症之感染患者（10.4%比4.2%, p=0.002）；而具臨床統計意義之死亡相關因子包括腦血管疾病、心臟病、急性呼吸衰竭、上胃腸道出血和急性腎衰竭。
結論：此研究報告之結果，提供急診醫師在診治感染症病患時，尤其在未有血液細菌培養報告結果前，一些重要的臨床判斷及評估預後之依據。

關鍵字

菌血症 ； 急診室 ； 危險及死亡相關因子

並列摘要

Objective: To determine the incidence, associated risk and mortality factors of bacteremia patients in the emergency department (ED).
Methods: A retrospective analysis study was performed on bacteremia patients who were admitted to the ED at a primary and referral teaching hospital between 2005 and 2006.
Results: During the study period, 701 patients (307 men and 394 women), with a mean age of 65.5 ± 17.5 years, were enrolled. The crude incidence rate was 0.6%. The most common clinical presentations and diagnosis were sepsis (52.4%) and urinary tract infection (36.4%), respectively. Escherichia coli (39.2%) was the most frequently isolated causative pathogen. Patients with bacteremia showed increased clinical severity and a higher hospitalization rate (p values＜0.001, respectively). On multivariate analysis, the significant associated risk factors for bacteremia were age ≥ 65 years, hypertension, cerebrovascular accident, chronic obstructive pulmonary disease, end stage of renal disease, anemia and bandemia. The rate of in-hospital mortality was significantly higher among bacteremia patients (10.4% versus 4.2%, p=0.002). On multivariate analysis, the mortality factors were cerebrovascular accident, cardiac disease, acute respiratory failure, upper-gastrointestinal bleeding and acute renal failure.
Conclusion: This study underscores the associated risks and mortality factors associated with bacteremia patients in the ED and provides emergency physicians with assessable variables that will allow them to target relevant septic patients before blood culture results are available.

並列關鍵字

bacteremia ； emergency department ； associated risk and mortality factors