加護病房包氏不動桿菌(Acinetobacter baumannii)院內血流感染死亡危險因子探討

Risk factors for in-hospital death from nosocomial Acinetobacter baumannii bacteremia in intensive care units

趙雪嵐(Hsueh-Lan Chao)

指導教授 ： 張志欽

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2006年)

摘要

背景：
包氏不動桿菌是重要感染致病菌，也是院內血流感染常見致病菌。由於具多重抗藥性及造成臨床各部位感染，因此更增加病患罹病率及死亡率危險性，同時導致病患延長住院天數及增加醫療成本。
目的：
調查包氏不動桿菌院內血流感染病患危險因子與死亡分析。
方法：
採回溯個案對照研究， 調查自2001年至2004成人加護病房血液培養包氏不動桿菌陽性，且經醫師依病患臨床症狀證實為血流感染者，並完成相關資料評估。
結果：
總共有82名包氏不動桿菌院內血流感染病患，男性57人，女性25人，平均年齡67歲，總住院天數平均55±45.4天，血流感染發生前總住院天數平均28±34.9天，血流感染發生前已停留加護病房天數平均18±23.4天。血流感染當時病患疾病嚴重度評估(Acute Physiology and Chronic Health Elevation , APACH II)平均27分。多重抗藥性佔54.9% ，其中9.8% 呈現泛抗藥性。有 62.2% 包氏不動桿菌血流感染病患有給予適當抗生素治療，住院期間死亡病患有42人(51.2%)，因包氏不動桿菌血流感染死亡有20人(24.4%)。單變項分析顯示；包氏不動桿菌感染發生死亡的相關危險因子有感染發生後器官衰竭(p=0.002)，其中心臟器官衰竭(p=0.006)，腎臟器官衰竭(p=0.001)，造血器官衰竭(p=0.010)，肝臟器官衰竭(p=0.001)，及抗生素呈多重抗藥性(p=0.001)。由多變數對數回歸分析發現，包氏不動桿菌血流感染死亡的相關因子為：多重菌種(p=0.004)，菌種產生多重抗藥性(p=0.001)，器官衰竭(p=0.010)。
結論：
當發生包氏不動桿菌血流感染時，多重菌種、菌種產生多重抗藥性及器官衰竭與死亡有高度相關性。

關鍵字：包氏不動桿菌，院內血流感染，多重抗藥性，泛抗藥性

關鍵字

包氏不動桿菌 ； 院內血流感染 ； 多重抗藥性 ； 泛抗藥性

並列摘要

Background:
Acinetobacter baumannii is an important opportunistic pathogen that is rapidly evolving toward multi-drug resistant and is involved in various severe nosocomial infections with increased mobility and mortality, prolonged hospital stay and increased total cost.
Objective:
To investigate the risk factors for in-hospital death in patients with nosocomial A. baumannii bacteremia.
Method:
A retrospective case-control study. We performed a systematic review of all blood culture results from patients hospitalized in intensive care unit (ICU) between 2001 and 2005. A baumannii bacteremia and mortality data were recorded.
Result:
A total of 82 ICU patients, 57 males and 25 females with average age of 67 years old, were included in this study. The average total length of stay was 55±45.4 days. The average total length of stay before contracting blood-stream infection was 28±34.9 days. The average total length of stay in ICU before contracting blood-stream infection was 18±23.4 days. The average APACH II score for all the patients at the time of blood-stream infection were 27. 54.9% of the A. baumannii isolations were multi-drug resistant, 9.8% of them were pan-drug resistant. Antimicrobials were appropriately used in 62.2% of patients. A total of 42 (51.2%) patients died in the hospital. 20 of these patients could be attributed to A. baumannii infections. From univariate analysis, the risk factors for in-hospital death from blood stream A. baumannii infections were renal insufficiency (p=0.005), multi-drug resistant (p=0.001), organ failure (p=0.002), included heart failure (p=0.006), renal failure (p=0.001), hemato-organ failure (p=0.010) and liver failure (p=0.001) and multi-drug resistant Acinetobacter baumannii (p=0.001). By using multivariate analysis, risk factors that were independently correlated with in-hospital death from Acinetobacter baumannii infection were polycomibal infections (p=0.004), isolates with multi-drug resistance (p=0.001), and organ failure (p=0.010).
Conclusion:
Mortality from bloodstream infection of A. baumannii was demonstrated to be highly related to polymicrobial infections, isolates multi-drug resistance and organ failure.

Keywords:Acinetobacter baumannii, nosocomial blood-stream infection multi-drug resistance, Pan-drug resistant.

並列關鍵字

Acinetobacter baumannii ； nosocomial blood-stream infection ； multi-drug resistant ； Pan-drug resistant

參考文獻

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