經驗性抗生素治療院內感染產生抗藥性菌種與病患住院特徵關係之研究

Inpatient risk factors associated with resistant empiric antimicrobial therapy in nosocomial infection

郭惠如(Hui-Ju Kuo)

指導教授 ： 吳信昇

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2007年)

摘要

目的：探討經驗性抗生素治療院內感染產生抗藥性菌種與病患住院特徵之相關性，提供爾後考量病患住院特徵選擇有效的經驗性抗生素治療院內感染。
方法：運用回溯性方法，收集2004年12月至2006年12月二年期間，某地區醫院院內感染個案為對象，回顧病歷及院內感染個案資料卡做評估並使用卡方或T檢定計算P值。
結果：共有72人發生103次院內感染。其經驗性抗生素的選擇以cephalosporins居多。分析病患住院特徵與發生經驗性抗生素治療產生抗藥性菌種間的百分比及其統計P值如下：出院後14天內再入院者佔44.9% (P=0.035)、住院時間超過30天者佔59.4% (P=0.021)、治療前30天曾使用cephalosporins者佔52.2% (P=0.006)及使用胃管者佔82.6% (P=0.045)，以carbapenems治療院內感染，其結果不具抗藥性之人次較多佔14.7% (P=0.038)。
結論：如病患住院特徵有：出院後14天內再入院、住院期間超過30天、治療前30天曾使用cephalosporins和使用胃管等情形時，需選擇經驗性抗生素治療院內感染時，建議可選用carbapenems來治療，比選用cephalosporins較不產生抗藥性菌種。

關鍵字

院內感染 ； 病患住院特徵 ； 經驗性抗生素

並列摘要

Object : This study have designed to understand relationship between inpatient risk factors and empiric antimicrobial therapy in nosocomial infections. The results of study will help to choose an effective empiric antimicrobial therapy by considering inpatient risk factors for treatment of nosocomial infections.
Methods : During the period of December 1, 2004 to December 31, 2006, cases of nosocomial infection in a hospital were evaluated by chart and nosocomial infection data card. Chi-square test and T test were used to calculate P value.
Result：103 cases of nosocomial infection were happened in 72 patients. And most common empiric antimicrobial therapies choosing by physician are cephalosporins. Inpatient risk factors such as: readmitted within 14 days 44.9% (P=0.035), hospitalization more than 30 days 59.4% (P=0.021), prior to use cephalosporins 52.2% (P=0.006) and use of nasal feeding tubes 82.6% (P=0.045) were significantly associated with resistant empiric antimicrobial therapy. Administration of carbapenems for treatment of nosocomial infection resulted in more non-resistant cases 14.7% (P=0.038).
Conclusions : As inpatient risk factors including readmitted within 14 days, hospitalization more than 30 days, prior to use cephalosporins and use of nasal feeding tube, we recommend that empiric antimicrobial therapy using carbapenems is better than cephalosporins, because carbapenems result few antibiotic- resistant pathogen.

並列關鍵字

nosocomial infection ； inpatient risk factors ； empiric antimicrobial therapy

參考文獻

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