院內感染控制雜誌/Nosocomial Infection Control Journal
衛生福利部疾病管制署,刊名變更
選擇卷期
- 期刊
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.
- 期刊
疥瘡是具有傳染性的皮膚疾患，乃疥蟲（SarcOPtes Scabiei）寄生於皮膚所致，其傳染途徑以密切接觸傳播為主，臨床上最主要症狀是皮膚發疹及劇癢。此次疥瘡群突發是發生在南部某區域教學醫院的加護病房，於七月份下旬皮膚就出現癢及紅疹，至民國90年7月31日為止，有十位護理人員及一位住院病患受到感染及疑似感染，分別於四肢、軀幹、背部及腹部等不同部位有癢及紅疹情形，其中下腹部及肚臍周圍出現紅疹有七人、大腿內側紅疹有五人、肘關節屈側紅疹有五人、軀幹結褲帶處紅疹有五人、腋窩前後緣紅疹有三人、背部紅疹有二人，其中有5位護理人員及1位住院病患共6位經皮膚科診斷確定為感染疥瘡，護理人員感染率為13.2 %，該加護病房住院病人感染率為4％。感管人員立即展開調查工作及必要之感染管制措施，包括對該單位已感染疥瘡之病患及護理人員予以Scalphen ointment治療，疑似感染疥瘡工作人員予以Eurax（Crolamiton）藥物治療，照護感染病患時採接觸隔離措施，並加強洗手、穿隔離衣、戴手套以及隔離防護之再教育等。此群突發之發生，追究極可能由於醫護人員認為感染來源之病患已擦藥二星期傳染力減低而未適時採取適當隔離措施所致，後經皮膚科醫師診斷及藥物治療以及嚴格的防護措施以及更衣室空間的改善措施後，該單位未再發現任何新的疥瘡個案。
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From 50 to 82.2% of the nosocomial isolates of Staph yloccus aureus and Staphylococcus epidermidis in major hospitals in Taiwan are oxacillin-resistant, and were 73% and 91% at our hospital. Glycopeptides are now being used frequently for the surgical prophylaxis. To assess the role of the vancomycin in the prophylaxis in coronary artery bypass surgery (CABG), we conducted a prospective study comparing two regimens of antibiotics: one with cefuroxime+gentamicin, and the other, cefuroxime+gentamicin+vancomycin. From January to July, 2000, 32 patients received the first regimen and 37 patients received the second. The two groups of patients were comparable in all potential risk factors. The result indicates that there were no statistical differences in the median hospital stay (11 days vs. 13 days; p=0,134), and episodes of post-operative infections (1 vs. 4; p=0.235). There was a significant difference in the cost of antibiotics between the two groups (NT 4,629 vs. NT 7,020; p=0,001). Our data suggest that the addition of vancomycin provides no extra benefit over cefuroxime + gentamicin in the surgical prophylaxis for the CABG. We suggest that vancomycin is not needed for the surgical prophylaxis in CABG.
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A retrospective study was performed to investigate predisposing factors, clinical manifestations, and prognosis of adult patients with nosocomial candidemia at Kaohsiung Medical University Hospital, from January, 1998, till September, 2000. There was a total of 109 patients with the infection, with the prevalence of 1.32 per 1,000 discharges. The average age of patients was 61.9±15.9 years (median 64). There was no difference between the mcidences in the male and the female. The infection was 9.6 times more common in the intensive care units than in the regular wards (7.59% vs. 0.79%; p ＜0.001). Pre-infection hospital stay was 43.7±71.5 days (median 25), and the total hospital stay was 5-6 time longer than that of the average patients (82.1 ±128 days vs. 14±16 days; p＜0.01). The infected cases had underlying haemato-oncologic diseases (47.7%), gastrointestinal diseases (38.5%), or diabetes mellitus (34.7%). The 3 most common invasive procedures applied during the pre-infection admission periods were the insertion of indwelling central venous catheters (76.1%), Foley catheters (66.1%), and endotracheal tubes (52.3%). During the same period, 82.6% were given more than 3 kinds of antibiotics, and 45% given H2 blockers. The most common pathogen was Candida albicans (43%), followed by C. tropicalis (20%), C. parapsilosis (7.3 %), and C. intermedia (6.4%). Antifungal agents were given to 86 patients to treat the infection. The mortality rate was 40.4%. The significant risk factors (p＜0.05) included the old age (66.16±14.75 years), underlying haemato-oncologic diseases, cachexia, and septic shock.