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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 方啟泰 | |
dc.contributor.author | Chiu-Hsia Su | en |
dc.contributor.author | 蘇秋霞 | zh_TW |
dc.date.accessioned | 2021-05-16T16:19:14Z | - |
dc.date.available | 2015-09-24 | |
dc.date.available | 2021-05-16T16:19:14Z | - |
dc.date.copyright | 2013-09-24 | |
dc.date.issued | 2013 | |
dc.date.submitted | 2013-08-12 | |
dc.identifier.citation | 1 Horan TC, Andrus M, Dudeck MA, Horan TC, Andrus M, et al. (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36: 309-332.
2 Burke JP (2003) Infection control - a problem for patient safety. N Eng J Med 348: 651-656. 3 World Health Organization (Geneva) (2005) WHO guidelines on hand hygiene in health care: clean hands are safer hands. Available: http://www.who.int/iris/handle/10665/69143. 4 Centers for Disease Control (Taiwan) (2009) Statistics of communicable diseases and surveillance report 2008. Available: www.cdc.gov.tw/uploads/files/307c10eb-9b59-487a-bd64-ab3518ab3758.pdf. Accessed 1 March 2013. 5 Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, et al. (2008) NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol 29:996–1011. 6 Blot SI, Vandewoude KH, Hoste EA, Colardyn FA. (2002) Outcome and attributable mortality in critically Ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Arch Intern Med 162:2229–2235. 7 Burton DC, Edwards JR, Horan TC, Jernigan JA, Fridkin SK, et al. (2009) Methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in US intensive care units, 1997–2007. JAMA 301:727–736. 8 Eber MR, Laxminarayan R, Perencevich EN, Malani A. (2010) Clinical and economic outcomes attributable to health care-associated sepsis and pneumonia. Arch Intern Med 170:347–353. 9 Lodise TP, McKinnon PS. (2007) Burden of methicillin-resistant Staphylococcus aureus: focus on clinical and economic outcomes. Pharmacotherapy 27:1001–1012. 10 Cluff LE, Reynolds RC, Page DL, Breckenridge JL (1968) Staphylococcal bacteremia and altered host resistance. Ann Intern Med 69: 859-873. 11 Julander I (1985) Unfavourable prognostic factors in Staphylococcus aureus septicemia and endocarditis. Scand J Infect Dis 17: 179-187. 12 Cosgrove SE, Sakoulas G, Perencevich EN, Schwaber MJ, Karchmer AW, et al. (2003) Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 36: 53-59. 13 Klevens RM, Edwards JR, Gaynes RP, National Nosocomial Infections Surveillance System. (2008) The impact of antimicrobial-resistant, healthcare-associated infections on mortality in the United States. Clin Infect Dis 47:927–930. 14 Fang CT, Shau WY, Hsueh PR, Chen YC, Wang JT, et al. (2006) Early empirical glycopeptide therapy for patients with methicillin-resistant Staphylococcus aureus bacteraemia: impact on the outcome. J Antimicrob Chemother 57:511–519. 15 Boyce JM, Cookson B, Christiansen K, Hori S, Vuopio-Varkila J, et al. (2005) Meticillin-resistant Staphylococcus aureus. Lancet Infect Dis 5: 653-663. 16 Chen ML, Chang SC, Pan HJ, Hsueh PR, Yang LS, et al. (1999) Longitudinal analysis of methicillin-resistant Staphylococcus aureus isolates at a teaching hospital in Taiwan. J Formos Med Assoc 98: 426-432. 17 Hsueh PR, Teng LJ, Chen WH, Pan HJ, Chen ML, et al. (2004) Increasing prevalence of methicillin-resistant Staphylococcus aureus causing nosocomial infections at a university hospital in Taiwan from 1986 to 2001. Antimicrob Agents Chemother 48: 1361-1364. 18 Whitby M, McLaws ML, Berry G (2001) Risk of death from methicillin-resistant Staphylococcus aureus bacteraemia: a meta-analysis. Med J Aust 175: 264-267. 19 Anderson DJ, Kaye KS, Chen LF, Schmader KE, Choi Y, et al. (2009) Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study. PLoS One 4:e8305. 20 Nixon M, Jackson B, Varghese P, Jenkins D, Taylor G. (2006) Methicillin-resistant Staphylococcus aureus on orthopaedic wards: incidence, spread, mortality, cost and control. J Bone Joint Surg 88:812–817. 21 McGarry SA, Engemann JJ, Schmader K, Sexton DJ, Kaye KS. (2004) Surgical-site infection due to Staphylococcus aureus among elderly patients: mortality, duration of hospitalization, and cost. Infect Control Hosp Epidemiol 25:461–467. 22 Engemann JJ, Carmeli Y, Cosgrove SE, Fowler VG, Bronstein MZ, et al. (2003) Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 36:592–598. 23 Abramson MA, Sexton DJ. (1999) Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 20:408–411. 24 Chaix C, Durand-Zaleski I, Alberti C, Brun-Buisson C. (1999) Control of endemic methicillin-resistant Staphylococcus aureus: a cost-benefit analysis in an intensive care unit. JAMA 282:1745–1751. 25 Leibovici L, Samra Z, Konigsberger H, Drucker M, Ashkenazi S, et al. (1995) Long-term survival following bacteremia or fungemia. JAMA 274:807–812. 26 Munoz-Price LS, Weinstein RA (2008) Acinetobacter infection. N Engl J Med 358: 1271-1281. 27 Gaynes R, Edwards JR, National Nosocomial Infections Surveillance S (2005) Overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis 41: 848-854. 28 Peleg AY, Seifert H, Paterson DL (2008) Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev 21: 538-582. 29 Fournier PE, Richet H (2006) The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis 42: 692-699. 30 Falagas ME, Rafailidis PI (2007) Attributable mortality of Acinetobacter baumannii: no longer a controversial issue. Crit Care (London, England) 11: 134. 31 Falagas ME, Bliziotis IA, Siempos II (2006) Attributable mortality of Acinetobacter baumannii infections in critically ill patients: a systematic review of matched cohort and case-control studies. Crit Care (London, England) 10: R48. 32 Giamarellou H, Antoniadou A, Kanellakopoulou K (2008) Acinetobacter baumannii: a universal threat to public health? Int J Antimicrob Agents 32: 106-119. 33 Kwon KT, Oh WS, Song JH, Chang HH, Jung SI, et al. (2007) Impact of imipenem resistance on mortality in patients with Acinetobacter bacteraemia. J Antimicrob Chemother 59: 525-530. 34 Perez F, Hujer AM, Hujer KM, Decker BK, Rather PN, et al. (2007) Global challenge of multidrug-resistant Acinetobacter baumannii. Antimicrob Agents 51: 3471-3484. 35 Lee NY, Lee HC, Ko NY, Chang CM, Shih HI, et al. (2007) Clinical and Economic Impact of Multidrug Resistance in Nosocomial Acinetobacter baumannii Bacteremia. Infect Control Hosp Epidemiol 28: 713-719. 36 Daniels TL, Deppen S, Arbogast PG, Griffin MR, Schaffner W, et al. (2008) Mortality rates associated with multidrug-resistant Acinetobacter baumannii infection in surgical intensive care units. Infect Control Hosp Epidemiol 29: 1080-1083. 37 Sunenshine RH, Wright MO, Maragakis LL, Harris AD, Song X, et al. (2007) Multidrug-resistant Acinetobacter infection mortality rate and length of hospitalization. Emerg Infect Dis 13: 97-103. 38 Maragakis LL, Perl TM (2008) Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis 46: 1254-1263. 39 Su CH, Wang JT, Hsiung CA, Chien LJ, Chi CL, et al. (2012) Increase of carbapenem-resistant Acinetobacter baumannii infection in acute care hospitals in Taiwan: association with hospital antimicrobial usage. PLoS ONE 7: e37788. 40 Tseng SH, Lee CM, Lin TY, Chang SC, Chang FY (2011) Emergence and spread of multi-drug resistant organisms: think globally and act locally. J Microbiol Immunol Infect 44: 157-165. 41 Su CH, Chang SC, Yan JJ, Tseng SH, Chien LJ, et al. (2013) Excess Mortality and Long-Term Disability from Healthcare-Associated Staphylococcus aureus Infections: a Population-Based Matched Cohort Study. PLoS ONE [In press]. 42 Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections, 1988. Am J Infect Control 16: 128-140. 43 National health insurance in Taiwan 2011. http://www.nhi.gov.tw/Resource/webdata/20774_1_NHI%20IN%20TAIWAN%202011%20ANNUAL%20REPORT.pdf. 44 Catastrophic Illness Patients. Bureau of National Health Insurance (Taiwan). http://www.nhi.gov.tw/English/webdata/webdata.aspx?menu=11&menu_id=596&WD_ID=596&webdata_id=3180. 45 Martin GS, Mannino DM, Eaton S, Moss M. (2003) The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 348:1546–1554. 46 Resch A, Wilke M, Fink C. (2009) The cost of resistance: incremental cost of methicillin-resistant Staphylococcus aureus (MRSA) in German hospitals. Eur J Health Econ 10:287–297. 47 Burke JP. (2003) Infection control – a problem for patient safety. N Engl J Med 348:651–656. 48 Sroka S, Gastmeier P, Meyer E. (2010) Impact of alcohol hand-rub use on meticillin-resistant Staphylococcus aureus: an analysis of the literature. J Hosp Infect 74:204–211. 49 Chen YC, Sheng WH, Wang JT, Chang SC, Lin HC, et al. (2011) Effectiveness and limitations of hand hygiene promotion on decreasing healthcare-associated infections. PLoS One 6:e27163. 50 Harbarth S, Sax H, Gastmeier P. (2003) The preventable proportion of nosocomial infections: an overview of published reports. J Hosp Infect 54:258–266. 51 Bode LG, Kluytmans JA, Wertheim HF, Bogaers D, Vandenbroucke-Grauls CM, et al. (2010) Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 362:9–17. 52 Blot S, Vandewoude K, Colardyn F, Blot S, Vandewoude K, et al. (2003) Nosocomial bacteremia involving Acinetobacter baumannii in critically ill patients: a matched cohort study. Intensive Care Med 29: 471-475. 53 Sanchez-Velazquez LD, Ponce de Leon Rosales S, Rangel Frausto MS (2006) The burden of nosocomial infection in the intensive care unit: Effects on organ failure, mortality and costs. A nested case-control study. Arch Med Res 37: 370-375. 54 Talbot GH, Bradley J, Edwards JE, Jr., Gilbert D, Scheld M, et al. (2006) Bad bugs need drugs: an update on the development pipeline from the Antimicrobial Availability Task Force of the Infectious Diseases Society of America. Clin Infect Dis 42: 657-668. 55 Garnacho J, Sole-Violan J, Sa-Borges M, Diaz E, Rello J, et al. (2003) Clinical impact of pneumonia caused by Acinetobacter baumannii in intubated patients: a matched cohort study. Cri Care Med 31: 2478-2482. 56 Chang HC, Chen YC, Lin MC, Liu SF, Chung YH, et al. (2011) Mortality risk factors in patients with Acinetobacter baumannii ventilator: associated pneumonia. J Formos Med Assoc 110: 564-571. 57 Lee SO, Kim NJ, Choi SH, Hyong Kim T, Chung JW, et al. (2004) Risk factors for acquisition of imipenem-resistant Acinetobacter baumannii: a case-control study. J Antimicrob Chemother 48: 224-228. 58 Del Mar Tomas M, Cartelle M, Pertega S, Beceiro A, Llinares P, et al. (2005) Hospital outbreak caused by a carbapenem-resistant strain of Acinetobacter baumannii: patient prognosis and risk-factors for colonisation and infection. Clin Microbiol Infec 11: 540-546. 59 Baran G, Erbay A, Bodur H, Onguru P, Akinci E, et al. (2008) Risk factors for nosocomial imipenem-resistant Acinetobacter baumannii infections. Int J Infect Dis 12: 16-21. 60 Tsai HT, Wang JT, Chen CJ, Chang SC (2008) Association between antibiotic usage and subsequent colonization or infection of extensive drug-resistant Acinetobacter baumannii: a matched case-control study in intensive care units. Diagn Micr Infec Dis 62: 298-305. 61 Shlaes DM, Gerding DN, John JF, Jr., Craig WA, Bornstein DL, et al. (1997) Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Clin Infect Dis 25: 584-599. 62 Goldmann DA, Weinstein RA, Wenzel RP, Tablan OC, Duma RJ, et al. (1996) Strategies to Prevent and Control the Emergence and Spread of Antimicrobial-Resistant Microorganisms in Hospitals. A challenge to hospital leadership. JAMA 275: 234-240. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/5999 | - |
dc.description.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。 | zh_TW |
dc.description.abstract | 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. | en |
dc.description.provenance | Made available in DSpace on 2021-05-16T16:19:14Z (GMT). No. of bitstreams: 1 ntu-102-D96842001-1.pdf: 637720 bytes, checksum: bf25627e5bd14257e63add4bd3a106f4 (MD5) Previous issue date: 2013 | en |
dc.description.tableofcontents | 口試委員會審定書 ii
誌謝 iii 中文摘要 iv Abstracts vi List of Figures xii List of Tables xiii Chapter 1: Introduction 1 1.1 Healthcare-Associated Infections 1 1.2 Taiwan Nosocomial Infection Surveillance System 1 1.3 Staphylococcus aureus Infections 2 1.4 Acinetobacter baumannii Infections 4 Chapter 2: Methods 8 2.1 Study Design 8 2.2 Objectives 8 2.3 Data Sources 8 2.4 Short-term vs. Long-term Impact of HAIs 9 2.5 Ethical Statement 10 2.6 Settings 10 2.7 HAI Surveillance and Notification 11 2.8 Patients with HAIs 12 2.9 Matched Inpatients without HAIs 12 2.10 Validation of Comparability 14 2.11 Ascertainment of Outcomes 14 2.12 Statistical Analysis 16 Chapter 3: Results 18 3.1 S. aureus HAI Study 18 3.1.1 Characteristics of Study Subjects 18 3.1.2 Impact of HAIs 19 3.2 A. baumannii HAI Study 21 3.2.1 Characteristics of Study Subjects 21 3.2.2 Impact of HAIs 22 3.2.3 Impact of Carbapenem Resistance 24 Chapter 4: Discussion 26 4.1 S. aureus HAI Study 26 4.2 A. baumannii HAI Study 30 4.3 Comparison of S. aureus and A. baumannii 35 Chapter 5: Conclusion 37 References 38 | |
dc.language.iso | en | |
dc.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 | zh_TW |
dc.title | Excess Mortality and Long-term Morbidity from Healthcare-associated Infections: Using Staphylococcus aureus and Acinetobacter baumannii as Examples | en |
dc.type | Thesis | |
dc.date.schoolyear | 101-2 | |
dc.description.degree | 博士 | |
dc.contributor.coadvisor | 張上淳 | |
dc.contributor.oralexamcommittee | 賴美淑,黃玉成,李文宗,簡麗蓉 | |
dc.subject.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, | zh_TW |
dc.subject.keyword | healthcare-associated infection,Staphylococcus aureus,Acinetobacter baumannii,carbapenem resistance,mortality,chronic ventilator dependence,dialysis-dependent end-stage renal disease, | en |
dc.relation.page | 79 | |
dc.rights.note | 同意授權(全球公開) | |
dc.date.accepted | 2013-08-12 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 流行病學與預防醫學研究所 | zh_TW |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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