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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
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dc.contributor.advisor | 方啟泰 | |
dc.contributor.author | Wan-Ting Lin | en |
dc.contributor.author | 林琬庭 | zh_TW |
dc.date.accessioned | 2021-06-17T01:20:31Z | - |
dc.date.available | 2022-09-14 | |
dc.date.copyright | 2017-09-14 | |
dc.date.issued | 2017 | |
dc.date.submitted | 2017-08-11 | |
dc.identifier.citation | 1 Wertheim HFL, Melles DC, Vos MC, et al. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 2005; 5(12): 751-62.
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J Clin Microbiol 2009; 47(9): 2957-63. 6 Huang YC, Hwang KP, Chen PY, Chen CJ, Lin TY. Prevalence of methicillin-resistant Staphylococcus aureus nasal colonization among Taiwanese children in 2005 and 2006. J Clin Microbiol 2007; 45(12): 3992-5. 7 Lin CJ, Chen YY. Using active surveillance in the early detection of methicillin-resistant Staphylococcus aureus colonization. Hu Li Za Zhi 2014; 61(1): 32-41. 8 Wang JT, Lauderdale TL, Lee WS, Huang JH, Wang TH, Chang SC. Impact of Active Surveillance and Contact Isolation on Transmission of Methicillin-resistant Staphylococcus aureus in Intensive Care Units in an Area With High Prevalence. J Formos Med Assoc 2010; 109(4):258–268. 9 Bradley SF. Eradication or Decolonization of Methicillin-Resistant Staphylococcus aureus Carriage: What Are We Doing and Why Are We Doing It? Clin Infect Dis 2007; 44(2):186-9. 10 Ammerlaan HS, Kluytmans JA, Wertheim HF, Nouwen JL, Bonten MJ. Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review. Clin Infect Dis 2009; 48(7): 922-30. 11 Batra R, Cooper BS, Whiteley C, Patel AK, Wyncoll D, Edgeworth JD. Efficacy and limitation of a chlorhexidine-based decolonization strategy in preventing transmission of methicillin-resistant Staphylococcus aureus in an intensive care unit. Clin Infect Dis 2010; 50(2): 210-7. 12 Buehlmann M, Frei R, Fenner L, Dangel M, Fluckiger U, Widmer AF. Highly effective regimen for decolonization of methicillin-resistant Staphylococcus aureus carriers. Infect Control Hosp Epidemiol 2008; 29(6): 510-6. 13 Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013; 368(24): 2255-65. 14 Lee YJ, Chen JZ, Lin HC, et al. Impact of active screening for methicillin-resistant Staphylococcus aureus (MRSA) and decolonization on MRSA infections, mortality and medical cost: a quasi-experimental study in surgical intensive care unit. Crit Care 2015; 19: 143. 15 Patel JB, Gorwitz RJ, Jernigan JA. Mupirocin resistance. Clin Infect Dis 2009; 49(6): 935-41. 16 Lee AS, Macedo-Vinas M, Francois P, et al. Impact of combined low-level mupirocin and genotypic chlorhexidine resistance on persistent methicillin-resistant Staphylococcus aureus carriage after decolonization therapy: a case-control study. Clin Infect Dis 2011; 52(12): 1422-30. 17 Walker ES, Vasquez JE, Dula R, Bullock H, Sarubbi FA. Mupirocin‐Resistant, Methicillin‐Resistant Staphylococcus aureus: Does Mupirocin Remain Effective? Infect Control Hosp Epidemiol 2003; 24(5):342-6.. 18 Deeny SR, Worby CJ, Tosas Auguet O, et al. Impact of mupirocin resistance on the transmission and control of healthcare-associated MRSA. J Antimicrob Chemother 2015; 70(12): 3366-78. 19 Hayden MK, Lolans K, Haffenreffer K, et al. Chlorhexidine and Mupirocin Susceptibility of Methicillin-Resistant Staphylococcus aureus Isolates in the REDUCE-MRSA Trial. J Clin Microbiol 2016; 54(11): 2735-42. 20 Cespedes C, Vavagiakis P, Klein RS, et al. The Clonality of Staphylococcus aureus Nasal Carriage. J Infect Dis 2005; 191(3):444-52. 21 Robicsek A, Beaumont JL, Peterson LR. Duration of colonization with methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2009; 48(7): 910-3. 22 Rogers C, Sharma A, Rimland D, et al. Duration of colonization with methicillin-resistant Staphylococcus aureus in an acute care facility: a study to assess epidemiologic features. Am J Infect Control 2014; 42(3): 249-53. 23 Larsson AK, Gustafsson E, Nilsson AC, Odenholt I, Ringberg H, Melander E. Duration of methicillin-resistant Staphylococcus aureus colonization after diagnosis: a four-year experience from southern Sweden. Scand J Infect Dis 2011; 43(6-7): 456-62. 24 Harris SR, Feil EJ, Holden MT, et al. Evolution of MRSA during hospital transmission and intercontinental spread. Science 2010; 327(5964): 469-74. 25 Grundmann H, Hori S, Winter B, Tami A, Austin DJ. Risk Factors for the Transmission of Methicillin-Resistant Staphylococcus aureus in an Adult Intensive Care Unit: Fitting a Model to the Data. J Infect Dis 2002; 185(4):481-8. 26 Lucet JC, Paoletti X, Demontpion C, et al. Carriage of Methicillin-Resistant Staphylococcus aureus in Home Care Settings. Arch Intern Med 2009; 169(15):1372-8. 27 Kwok KO, Cowling BJ, Wei VW, et al. Social contacts and the locations in which they occur as risk factors for influenza infection. Proc Biol Sci 2014; 281(1789): 20140709. 28 Simor AE, Stuart TL, Louie L, et al. Mupirocin-resistant, methicillin-resistant Staphylococcus aureus strains in Canadian hospitals. Antimicrob Agents Chemother 2007; 51(11): 3880-6. 29 Johnson PD, Martin R, Burrell LJ, et al. Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Med J Aust 2005; 183(10):509-14. 30 Chen WT, Wang JT, Lee WS, et al. Performance of the BD GeneOhm Methicillin-resistant Staphylococcus aureus (MRSA) PCR Assay for Detecting MRSA Nasal Colonization in Taiwanese Adults. J Microbiol Immunol Infect 2010; 43(5): 372-7. 31 Life expectancy from Ministry of the Interior (Taiwan, ROC). http://www.moi.gov.tw/stat/chart.aspx?ChartID=S0601 2017/8/10 32 Discharge rate from Ministry of Health and Welfare. http://www.nhi.gov.tw/Content_List.aspx?n=E13DFC9EA4B8083B&topn=CDA985A80C0DE710 2017/8/10 | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/67121 | - |
dc.description.abstract | 背景:抗藥性金黃色葡萄球菌 (Methicillin-resistant Staphylococcus aureus, MRSA) 是院內感染重要致病菌。即使以抗生素治療,一旦感染就會造成額外的死亡風險、不可逆呼吸器依賴及長期洗腎、以及額外住院花費等。使用含Mupirocin成分的鼻內軟膏對帶菌者做去移生治療已被證實可降低病人後續的感染風險,但去移生介入政策最大的顧慮在於可能導致Mupirocin抗藥性比例上升。然而,不同去移生政策對醫院內及社區中MRSA感染率及MRSA Mupirocin抗藥性的長期影響尚未被釐清。
方法:這是一個數理模式研究,我們先建構一個考慮Mupirocin抗藥性的院內傳染動態模型,使不同mupirocin抗藥性的MRSA可以在醫院內經由病人及醫護人員傳播。再建構一個社區的傳染動態模型,使MRSA可以在社區中進行傳播,並連結醫院及社區,模擬MRSA在不同醫院間及社區中傳播的動態。然後模擬去移生介入政策對MRSA感染率及Mupirocin抗藥性的影響,並利用台大醫院感染率變化趨勢的資料及台灣2010-2014年MRSA盛行率實證研究來校正模型參數,最後評估不同介入政策對降低MRSA感染率和提高Mupirocin抗藥性MRSA比例的影響。 結果:相較於未介入情境,Targeted decolonization與Universal decolonization皆能有效降低MRSA感染率 (10年後降低64.2% vs. 61.5%),但Universal decolonization會伴隨較大的Mupirocin抗藥性比例上升 (10年後為4.91倍),且隨著時間增加,兩者抗藥性比例的差異愈大 (50年後為46.48倍)。相較於僅持續推動洗手運動,洗手運動加上Targeted decolonization可進一步降低64.2%-71.4% MRSA感染率,在十年內預防46.5%-47.6% MRSA感染病例,並避免45.9%-47.2%的MRSA相關死亡。 結論:Targeted decolonization是一個能有效降低MRSA感染率的介入政策,並且伴隨著較小的Mupirocin抗藥性比例上升。在目前洗手運動基礎上,進一步實施Targeted decolonization可預防將近一半的MRSA 感染及死亡案例。 | zh_TW |
dc.description.abstract | Background: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading cause of nosocomial infections. Even with antibiotics treatment, nosocomial MRSA infections are still associated with excess mortality, morbidity, and extra cost of medical expenditure. Mupirocin-based decolonization regimens effectively reduce MRSA infection rate and related mortality. However, the major concern of MRSA decolonization is emergence of mupirocin-resistance in MRSA. We aim to evaluate the long-term effect of different decolonization strategies on both mupirocin resistance and MRSA infection rate, using a dynamic model fit to Taiwan national data.
Methods: We constructed a deterministic model that simulates mupirocin-sensitive MRSA and mupirocin-resistant MRSA strains transmitted between patients and health-care workers within hospitals, as well as between discharged patients and community residents. We fit the model to the trend of 1997-2016 MRSA infection rate at National Taiwan University Hospital (NTUH) and 2010-2014 MRSA prevalence survey in Taiwan. We compared the impact of different national decolonization polices on the reduction of MRSA infection rate and increase of mupirocin-resistant MRSA in hospitals and community. Findings: Compared to baseline scenario (no intervention), both targeted and universal decolonization reduce nosocomial MRSA infection rates (64·2% and 61·5% after 10 years, respectively). However, universal decolonization causes significantly higher mupirocin resistance (4·91 times after 10 years), and the difference increases with time (46·48 times after 50 years). Sensitivity analyses show that the above-stated findings are robust across a wide range of parameter values. Compared to no intervention scenario (continuing hand hygiene campaign, without decolonization), implementation of targeted decolonization over the next 10 years would reduce nosocomial MRSA infection rate by 64·2%-71·4%, prevent 46·5%-47·6% cases of MRSA infections, and avert 45·9%-47·2% of MRSA-related deaths. Interpretation: Our results support targeted decolonization as an effective national intervention policy to reduce MRSA disease burden, with a minimal impact on mupirocin resistance. Funding: No | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T01:20:31Z (GMT). No. of bitstreams: 1 ntu-106-R04849024-1.pdf: 2543536 bytes, checksum: 44b5959c7909b21cf2facd1677ec5bcf (MD5) Previous issue date: 2017 | en |
dc.description.tableofcontents | 摘要 iii
Summary v Table of Contents vii List of Tables ix List of Figure x Introduction 1 Methods 3 Study Design 3 Model Specification 4 Modeling Decolonization Policies 5 Parameterization 7 Sensitivity Analysis 9 Results 10 Targeted decolonization vs. Universal decolonization 10 Impact of targeted decolonization 11 Necessity of targeted decolonization 11 Sensitivity Analysis 11 Discussion 13 Reference 17 Supplementary appendix 31 | |
dc.language.iso | en | |
dc.title | 比較Targeted與Universal去移生介入政策對全國抗藥性金黃色葡萄球菌感染率及Mupirocin抗藥性的長期影響: 數理模式研究 | zh_TW |
dc.title | Targeted vs Universal Decolonization of Methicillin-Resistant Staphylococcus aureus: A Population-Based Dynamic Modeling Study | en |
dc.type | Thesis | |
dc.date.schoolyear | 105-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 林先和,簡麗蓉,王振泰 | |
dc.subject.keyword | 抗藥性金黃色葡萄球菌,院內感染,Mupirocin抗藥性,感染控制,去移生,篩檢,數理模式, | zh_TW |
dc.subject.keyword | Methicillin-resistant Staphylococcus aureus,hospital-acquired infection,mupirocin resistance,infection control,decolonization,screening,mathematical modelling, | en |
dc.relation.page | 50 | |
dc.identifier.doi | 10.6342/NTU201703017 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2017-08-11 | |
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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