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Title: | 院內感染相關額外死亡與長期罹病:以金黃色葡萄球菌與鮑氏不動桿菌為例 Excess Mortality and Long-term Morbidity from Healthcare-associated Infections: Using Staphylococcus aureus and Acinetobacter baumannii as Examples |
Authors: | Chiu-Hsia Su 蘇秋霞 |
Advisor: | 方啟泰 |
Keyword: | 院內感染,金黃色葡萄球菌,鮑氏不動桿菌,抗藥性,死亡率,慢性呼吸器依賴,末期腎病透析依賴, healthcare-associated infection,Staphylococcus aureus,Acinetobacter baumannii,carbapenem resistance,mortality,chronic ventilator dependence,dialysis-dependent end-stage renal disease, |
Publication Year : | 2013 |
Degree: | 博士 |
Abstract: | 背景:院內感染 (Healthcare-associated infection) 是住院病人常見的併發症,其中金黃色葡萄球菌 (Staphylococcus aureus) 是重要的致病菌,但過去研究欠缺對於感染金黃色葡萄球菌後,是否增加長期額外死亡或罹病風險的評估。另外,對碳青黴烯類抗生素產生抗藥性的鮑氏不動桿菌 (carbapenem-resistant Acinetobacter baumannii) 於近年來越來越常見,但是碳青黴烯類抗生素抗藥性是否會增加死亡風險或罹病風險,過去研究則未有定論。本研究以金黃色葡萄球菌和鮑氏不動桿菌為例,探討院內感染是否增加長期死亡或罹病風險。於金黃色葡萄球菌院內感染研究中,研究目的為評估相較於未感染的對照病人,金黃色葡萄球菌院內感染長期是否增加死亡風險或罹病風險;於鮑氏不動桿菌院內感染研究中,研究目的為評估相較對碳青黴烯類抗生素具感受性鮑氏不動桿菌感染病例,碳青黴烯類抗生素抗藥性是否會增加感染鮑氏不動桿菌個案的長期死亡風險或罹病風險。
方法:本研究以參與台灣院內感染監視系統 (Taiwan Nosocomial Infection Surveillance, TNIS) 通報的醫院為研究對象,採回溯性族群基礎的配對世代研究法,以1:2的比例選取與院內感染個案相同配對條件的非院內感染個案,配對條件包括醫院、性別、年齡、就醫科別、潛在疾病及院內感染前住院日數。在院內感染金黃色葡萄球菌研究中,總共納入3070名金黃色葡萄球菌院內感染個案,及6140名配對的非院內感染個案。在院內感染鮑氏不動桿菌研究中,總共納入2213名鮑氏不動桿菌院內感染個案,及4426名配對的非院內感染個案。主要研究測量為1年額外死亡率、新發慢性呼吸器依賴及新發末期腎病透析依賴的風險。 結果:在院內感染金黃色葡萄球菌研究中,我們發現住院病人院內感染金黃色葡萄球菌的1年死亡率較配對的非院內感染病人額外增加20.2%的死亡風險 (P<0.001)。新發慢性呼吸器依賴及末期腎病透析依賴的風險則分別額外增加7.3%和2.6% (Ps<0.001)。每件金黃色葡萄球菌院內感染平均可延長住院天數12天,增加醫療費用5978美元(Ps<0.001)。在院內感染鮑氏不動桿菌研究中,我們發現住院病人感染碳青黴烯類抗生素抗藥性鮑氏不動桿菌的1年死亡率,較感染對碳青黴烯類抗生素具感受性鮑氏不動桿菌 (carbapenem-susceptible A. baumannii) 的病人額外增加11.8% (P<0.001)。碳青黴烯類抗生素抗藥性會增加新發慢性呼吸器依賴的風險為5.2% (Ps<0.001);每件碳青黴烯類抗生素抗藥性平均可增加感染鮑氏不動桿菌住院病人的醫療費用2511美元 (Ps<0.001)。 結論:不論是院內感染金黃色葡萄球菌或鮑氏不動桿菌都有顯著的長期負面效應,包括額外死亡率和增加罹病率;而且院內感染抗藥性鮑氏不動桿菌也較非抗藥性鮑氏不動桿菌導致較高的死亡和罹病發生。本研究建議未來推動相關感染管制計畫和抗生素管理措施的成效評估時,應一併將院內感染及抗藥性所引起的長期死亡及罹病一併納入防治成本效性分析。 Background: Healthcare-associated infection (HAI) is one of the most common complications affecting hospitalized patients. Staphylococcus aureus is a leading cause of HAIs, but the impact of S. aureus HAIs on the long-term survival and functional status of hospitalized patients remain unknown. Beside, carbapenem-resistant Acinetobactor baumannii (CRAB) has emerged as a major cause of HAIs, but the impact of carbapenem resistance on the long-term outcomes in patients with A. baumannii HAIs has not yet been well studied. This study aimed to examine whether HAIs increase the risks for long-term mortality and disability, using S. aureus and A. baumannii as examples. In the S. aureus HAI study, we aimed to examine whether S. aureus HAIs increase the risks for long-term mortality and disability. In the A. baumannii HAI study, we aimed to examine whether carbapenem resistance increase the risks for long-term mortality and disability after A. baumannii HAIs. Methods: We conducted a retrospective population-based matched cohort study of hospitalized patients in acute care hospitals which participated in Taiwan Nosocomial Infection Surveillance (TNIS). We individually matched patients with HAIs to inpatients without HAIs at a 1:2 ratio by age, gender, hospital, specialty, underlying diseases, and the length of stay before onset of the HAI. In the S. aureus HAIs study, we included 3070 inpatients with S. aureus HAIs and 6140 matched uninfected inpatients. In the A. baumannii HAIs study, 2213 inpatients with A. baumannii HAIs and 4426 matched uninfected inpatients were included. Main outcome measures are one-year excess risks for mortality, new-onset chronic ventilator dependence, and new-onset dialysis-dependent end-stage renal disease. Results: For the S. aureus HAI study, patients with S. aureus HAIs had an excess one-year mortality of 20.2% compared with matched uninfected inpatients (P<0.001). The excess risk for new-onset chronic ventilator dependence and dialysis-dependent end-stage renal disease was 7.3% and 2.6%, respectively (Ps<0.001). S. aureus HAIs were also associated with an excess hospital stay of 12 days and an extra cost of US $5978 (Ps<0.001). For the A. baumannii HAI study, carbapenem resistance was associated with an increased excess one-year mortality of 11.8% in CRAB patients compared with carbapenem-susceptible A. baumannii (CSAB) patients (P <0.001). The excess risk of carbapenem resistance for new-onset chronic ventilator dependence was 5.2% (P <0.001). Carbapenem resistance was also associated with an extra cost of US $2511 (P <0.001). Conclusion: Both S. aureus HAIs and A. baumannii HAIs have substantial negative effect on the long-term outcome of hospitalized patients in terms of both mortality and disability. Furthermore, carbapenem resistance in patients with A. baumannii HAIs further increased the risk for adverse long-term outcomes. The negative impact on the long-term outcome should be taken into consideration in future cost-effectiveness studies of the control and prevention interventions for S. aureus HAIs and A. baumannii HAIs. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/5999 |
Fulltext Rights: | 同意授權(全球公開) |
Appears in Collections: | 流行病學與預防醫學研究所 |
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