某醫學中心成人加護病房八年來院內菌血症之探討

Analysis of Nosocomial Bloodstream Infections in Intensive Care Units at a Medical Center in Taiwan

鄧碧珠(Pi-Chu Teng) ； 張藏能(Tsrang-Neng Jang) ； 黃建賢(Chien-Shien Huang) ； 沈淑惠(Shu-hui Shen) ； 李淑華(Shu-Hua Lee)

《院內感染控制雜誌》 12卷6期 (2002/12) Pp. 325-336

摘要

This retrospective study reviewed the medical records of all patients who had nosocomial bacteremia in intensive care units of a medical center in Taipei from 1993 till 2000. There were 685 episodes of bacteremia that developed nosocomially in 596 patients. The average annual crude incidence rate was 3.4%, and the incidence density was 5.4¢X/oo. A total of 816 strains of micro-organisms was isolated; 15.6% of the patients had multiple pathogens. 258 patients died. There were 49.5% Gram-negative bacteria, 24.4% Gram- positives, 9.8% fungi, and 0.9% anaerobes. The most commonly isolated were: Staphylococcus aureus (16.1%) (87.8% of which were methicillin-resistant), Acinetobcter spp. (15.1%), fungi (10.3%), Enterobacter cloacae (6.6%), and coagulase-negative staphylococci (5.8%). Statistical differences (by chi-square test) were present among annual incidences of bacteremias caused by S. aureus, fungi, Serratia spp, and Burkholderia cepacia (P＜0.05). The sources of the bacteremia were identified in 48%. The major sources of the infection were: lower respiratory (16.4%), intravenous catheters (8.2%), and urinary tract (5.3%). The highest mortality rate was seen in cases secondary to the urinary tract infection (44.4%). Acinetobacter spp. were the most frequently isolated organisms between 1993 till 1996; whereas Staphylococcus aureus was the most important since 1997. Catheters inserted into patients were independently predictive of the bloodstream infections.

關鍵字

菌血症 ； 院內感染 ； 加護病房 ； 個案死亡率

並列摘要

This retrospective study reviewed the medical records of all patients who had nosocomial bacteremia in intensive care units of a medical center in Taipei from 1993 till 2000. There were 685 episodes of bacteremia that developed nosocomially in 596 patients. The average annual crude incidence rate was 3.4%, and the incidence density was 5.4¢X/oo. A total of 816 strains of micro-organisms was isolated; 15.6% of the patients had multiple pathogens. 258 patients died. There were 49.5% Gram-negative bacteria, 24.4% Gram- positives, 9.8% fungi, and 0.9% anaerobes. The most commonly isolated were: Staphylococcus aureus (16.1%) (87.8% of which were methicillin-resistant), Acinetobcter spp. (15.1%), fungi (10.3%), Enterobacter cloacae (6.6%), and coagulase-negative staphylococci (5.8%). Statistical differences (by chi-square test) were present among annual incidences of bacteremias caused by S. aureus, fungi, Serratia spp, and Burkholderia cepacia (P＜0.05). The sources of the bacteremia were identified in 48%. The major sources of the infection were: lower respiratory (16.4%), intravenous catheters (8.2%), and urinary tract (5.3%). The highest mortality rate was seen in cases secondary to the urinary tract infection (44.4%). Acinetobacter spp. were the most frequently isolated organisms between 1993 till 1996; whereas Staphylococcus aureus was the most important since 1997. Catheters inserted into patients were independently predictive of the bloodstream infections.

並列關鍵字

bacteremia ； nosocomial infections ； intensive care unints ； case fatality