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DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 張上淳 | |
dc.contributor.author | Chia-Nung Lin | en |
dc.contributor.author | 林佳濃 | zh_TW |
dc.date.accessioned | 2021-06-15T04:46:06Z | - |
dc.date.available | 2011-09-13 | |
dc.date.copyright | 2010-09-13 | |
dc.date.issued | 2010 | |
dc.date.submitted | 2010-08-05 | |
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/45785 | - |
dc.description.abstract | 目的:
探討本地非傷寒沙門氏桿菌菌血症之抗生素治療習慣、死亡率及影響死亡的危險因子,分別分析發生非傷寒沙門氏桿菌菌血症移轉之局部感染及血管內移轉感染的危險因子。 研究設計、地點及研究對象: 本研究於國立臺灣大學醫學院附設醫院,位於臺灣北部的醫學中心,以蒐集病歷資料進行單醫學中心的回溯性世代分析研究。自2006年1月1日至2009年12月31日期間確定有感染非傷寒沙門氏菌菌血症的病人,並只納入第一次感染事件,排除多重菌種感染病人以及同時有其他部位非傷寒沙門氏桿菌以外菌種感染的病人。 研究方法: 以研究開始前設計之病歷個案報告表查閱研究對象之紙本和電子病歷之相關資料,包含病人基本資料、合併症以及造成感染的潛在因子、菌血症發作前30天是否有細菌感染之情形以及治療方式和抗生素使用情形、菌血症發作時之細菌培養和抗生素敏感性測試結果、臨床表徵、相關檢驗數據、治療結果。本研究的觀察終點是全體病人於30天內的死亡率。 統計方法包含卡方檢定(χ2 test)、無母數檢定(Mann-Whitney U test)、T檢定(t-test)、費雪檢定(Fisher’s exact test)。存活分析使用Kaplan-Meier method繪製存活曲線並以Log-rank test比較差異。死亡危險因子、發生移轉局部感染的危險因子以及發生血管內移轉感染的分析利用單變項分析及多變項羅吉思逐步回歸分析。 結果: 共有155位感染非傷寒沙門氏桿菌菌血症的病人。病人平均年齡為55.3±16.7歲,範圍為19歲到93歲,男與女比例為2.04:1.0,有88位(56.8 %)病人為社區型感染,Charlson’s comorbidity score中位數為4分,病人合併症最多的為癌症(49.0 %)、次為肝膽疾病(36.1 %),平均住院天數為21天,菌株血清型最多為serogroup D1,感染月份以7月到10月最多,其中以8月的感染事件最多(14.2 %),菌血症發作時臨床表徵以敗血症最多(52.3 %),菌血症發作時的Pitt bacteremia score中位數為1分,發生腸胃道症狀的占57.4 %,三十天內的死亡率為18.1 %。Ampicillin、chloramphenicol、co-trimoxazolee和ciprofloxacin的抗藥性和不同的菌株之間有顯著的關係,只有ceftriaxone的抗藥性和不同血清型無顯著的關係。 全體病人中有28位發生局部移轉感染,其中以9位病人發生血管內感染佔最多(32.1 %)。針對血管內移轉感染的危險因子分析,發現年齡越長(OR:1.07;95 % C.I.:1.01~1.12;p = 0.022)為發生非傷寒沙門氏桿菌菌血症血管內移轉感染之獨立危險因子。 全體病人多變項分析影響30天內死亡率之危險因子,包含臨床表徵為敗血性休克(OR:8.86;95 % C.I.:3.40~23.10;p < 0.0001)、Charlson’s comorbidity score較嚴重者(OR:1.30;95 % C.I.:1.08~1.56;p = 0.0047),為非傷寒沙門氏桿菌菌血症30天內死亡率的獨立危險因子。進行非後天免疫缺乏症後群之病人之影響30天內死亡率之危險因子,包含Charlson’s comorbidity score(OR:1.40;95 % C.I.:1.15~1.69;p = 0.0006)較嚴重以及Pitt bacteremia score(OR:1.80;95 % C.I.:1.38~2.35;p < 0.0001)較嚴重為非傷寒沙門氏桿菌菌血症30天內死亡率的獨立危險因子。針對全體病人使用經驗性和確切性抗生素的適當性與否以及是否延遲使用抗生素治療皆和死亡預後無顯著關係。 結論: 感染非傷寒沙門氏桿菌菌血症的病人,年齡越長的病人較易發生血管內移轉感染。感染非傷寒沙門氏桿菌菌血症的病人,30天內的死亡率和病人本身情況的嚴重程度Charlson’s comorbidity score有關以及感染菌血症臨床表徵為敗血性休克有關。針對非後天免疫缺乏症候群的病人,30天內的死亡率和病人本身情況的嚴重程度Charlson’s comorbidity score有關以及Pitt bacteremia score較嚴重有關。 關鍵詞: 非傷寒沙門氏桿菌、菌血症、危險因子、腸胃道外移轉的局部感染、血管內移轉感染、死亡率、適當抗生素治療。 | zh_TW |
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dc.description.tableofcontents | 中文摘要 I
Abstract IV 目錄 VII 圖目錄 X 表目錄 XI 附表目錄 XIII 中英對照表 XIV 第一章 緒論 1 第二章 文獻回顧 3 第1節 細菌學 3 第2節 抗藥性機轉 5 第3節 流行病學 7 2.3.1 各地盛行率 7 2.3.2 臺灣盛行率 8 第4節 非傷寒沙門氏桿菌之體外藥物敏感性試驗 9 第5節 非傷寒沙門氏桿菌菌血症之治療 10 2.5.1 抗生素治療選擇 10 2.5.2 適當抗生素治療與否與延遲抗生素治療和預後之關係 11 第6節 感染非傷寒沙門氏桿菌菌血症的危險因子 12 第7節 非傷寒沙門氏桿菌移轉的局部感染 14 第8節 影響非傷寒沙門氏桿菌預後之危險因子 15 2.8.1 死亡率 15 2.8.2 死亡危險因子 16 第三章 研究目的 19 第四章 研究方法 20 第1節 研究架構 20 第2節 研究地點及研究對象 21 4.2.1 納入條件 21 4.2.2 排除條件 22 第3節 資料收集 22 4.3.1 病人基本資料 22 4.3.2 病人合併症及相關造成感染潛在因子 23 4.3.3 非傷寒沙門氏桿菌菌血症發作前感染及醫療處置 23 4.3.4 非傷寒沙門氏桿菌菌血症發作時之資料收集 24 4.3.5 抗生素治療 24 4.3.6 後續追蹤非傷寒沙門氏桿菌檢體 25 4.3.7 後續感染 25 4.3.8 預後因子 25 4.3.9 治療結果 26 第4節 名詞定義 26 4.4.1 院內感染 26 4.4.2 社區感染 26 4.4.3 醫療照護相關感染 27 4.4.4 免疫低下 27 4.4.5 臨床表徵 27 4.4.6 經驗療法與確切療法 28 4.4.7 評估治療之適當性 28 4.4.8 非傷寒沙門氏桿菌移轉的局部感染 29 第5節 統計分析方法 29 第五章 研究結果 31 第1節 描述性統計 31 5.1.1 收案過程與病人數 31 5.1.2 病人基本資料 32 5.1.3 病人合併症 33 5.1.4 造成感染之潛在因子 34 5.1.5 先前使用之抗生素 36 5.1.6 感染非傷寒沙門氏桿菌菌血症事件在各月份分布 37 5.1.7 疾病嚴重程度及臨床表徵 37 5.1.8 死亡率 38 5.1.9 非傷寒沙門氏桿菌體外之抗生素敏感性試驗 39 5.1.10抗生素治療處方 43 5.1.11 抗生素治療處方之適當性 46 5.1.12 抗生素治療適當與否和死亡率之關係 48 5.1.13 確切性抗生素使用種類和D30死亡率之關係 49 5.1.14 延遲適當抗生素之使用和死亡率之關係 50 5.1.15 抗生素種類和達到臨床治療效果之關係 52 5.1.16 非傷寒沙門氏桿菌菌血症移轉的局部感染 54 第2節 存活分析 55 第3節 發生非傷寒沙門氏桿菌移轉局部感染的危險因子 59 第4節 感染非傷寒沙門氏桿菌菌血症死亡的危險因子 69 第六章 討論 79 第1節 病人族群及菌株相關資料 79 第2節 抗生素治療和治療結果及死亡率之關係 81 第3節 延遲抗生素治療和死亡率之關係 84 第4節 非傷寒沙門氏桿菌菌血症移轉的局部感染 84 第5節 死亡率分析 87 第6節 影響非傷寒沙門氏桿菌菌血症預後之危險因子 87 第7節 研究限制 90 6.7.1 資料收集 90 6.7.2 研究地點及病人族群 90 6.7.3 缺乏MIC、其他類抗生素之敏感性試驗及菌株相關資料 91 第七章 結論 92 第八章 參考資料 93 | |
dc.language.iso | zh-TW | |
dc.title | 影響非傷寒沙門氏桿菌菌血症預後之危險因子分析:著重於抗生素藥物治療 | zh_TW |
dc.title | Analysis of prognosis factors for non-typhoid Salmonella bloodstream infection with emphasis on antimicrobial treatment | en |
dc.type | Thesis | |
dc.date.schoolyear | 98-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 林慧玲,林淑文,王振泰 | |
dc.subject.keyword | 非傷寒沙門氏桿菌,菌血症,危險因子,腸胃道外移轉的局部感染,血管內移轉感染,死亡率,適當抗生素治療, | zh_TW |
dc.subject.keyword | Non-typhoid salmonella,bacteremia,risk factor,extraintestinal focus of infection,endovascular focus of infection,mortality,adequate antimicrobial therapy, | en |
dc.relation.page | 108 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2010-08-06 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床藥學研究所 | zh_TW |
顯示於系所單位: | 臨床藥學研究所 |
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