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標題: | 比較抗藥性及非抗藥性金黃色葡萄球菌院內血流感染導致死亡、長期失能、及醫療費用支出之差異 Mortality, long-term disability, and medical expenditure: methicillin-resistant versus methicillin-sensitive Staphylococcus aureus bacteremia |
作者: | Chun-Chun Yeh 葉竹君 |
指導教授: | 方啟泰(Chi-Tai Fang) |
關鍵字: | 醫療照護相關感染,血流感染,金黃色葡萄球菌,長期失能,醫療支出, healthcare-associated infections,bloodstream infection,bacteremia,Staphylococcus aureus,long-term disability,medical expenditure, |
出版年 : | 2019 |
學位: | 碩士 |
摘要: | 背景及目的:醫療照護相關感染(healthcare-associated infection, HAI)是影響病人安全的主要原因之一,常造成病人的住院天數延長、醫療費用增加及死亡風險等。金黃色葡萄球菌(Staphylococcus aureus)為HAI的主要致病原之一。過去針對S. aureus血液感染所造的HAI,其研究內容大多探討MRSA及MSSA之間的死亡率、住院天數及醫療花費是否有所差異,但並未比較兩者間在導致長期失能上是否會有所不同。故此研究目的主要針對S. aureus血液感染在抗藥性與非抗藥性間,除了比較死亡風險及醫療花費外,對於未來是否會增加呼吸器長期依賴或是長期血液透析的風險。
方法:採回溯性研究方式收集臺中榮民總醫院2010年1月1日至2017年12月31日,經醫療照護相關感染定義收案為血流感染且感染菌種為S. aureus之個案,並將個案分成MSSA及MRSA兩組,使用Cox Proportional Hazard Model進行後續分析。 結果:此研究共收集228位個案,其中暴露組(MRSA)為147位,非暴露組(MSSA)則為81位。MRSA組的平均醫療費用支出(NT$570,555)較MSSA的平均醫療費用支出(NT$348,887)高(p=0.001);MRSA發生死亡風險是MSSA的1.67倍(95% CI 0.94-2.95);MRSA發生申請血液透析重大傷病卡的風險是MSSA的1.64倍(95% CI 0.38-7.14);MRSA發生新申請呼吸器重大傷病卡風險是MSSA的1.32倍(95% CI 0.26-6.73)。 結論:研究顯示MRSA血流感染的病人在死亡率、慢性血液透析及呼吸器依賴上皆有較差的結果,故落實院內MRSA防治的感染管制措施是非常重要的。 Background and purpose:Hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) is associated with an excess mortality, prolonged hospital stay, and extra medical cost, compared with hospital-acquired methicillin-sensitive S. aureus (MSSA) BSI. The aims of our study to compare the risk of new-onset long-term hemodialysis and ventilator dependence between MRSA BSI and MSSA BSI. Method:This is a retrospective cohort study of all inpatients had healthcare-associated infections (HAI) with S. aureus BSIs at Taichung Veterans General Hospital (Taichung, Taiwan), between 1 January 2010 and 31 December 2017. We compared MSSA and MRSA BSIs for medical cost, mortality, new-onset long-term hemodialysis and new-onset ventilator dependence. We used Cox proportional hazard regression to adjust for the effects of confounding factors. Result:There were 147 MRSA BSIs and 81 MSSA BSIs during the study period. The mean medical expenditure were NT$570,555 for MRSA and NT$348,887 for MSSA (p=0.001). In comparison with patients with MSSA BSI, patients with MRSI BSI had an increase in risk of mortality (hazard ratio [HR] 1.67, 95% CI 0.94-2.95), new-onset dialysis-dependence (HR 1.64, 95% CI 0.38-7.14) and new-onset ventilator dependence (HR 1.32, 95% CI 0.26-6.73) after adjusting for severity of sepsis and the comorbidities. Conclusion:Patients with MRSA BSI tend to have poorer outcomes, in term of both acute mortality and chronic dialysis/ventilator-dependence. Our results highlight the importance of hospital-acquired MRSA infection control. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/74531 |
DOI: | 10.6342/NTU201902622 |
全文授權: | 有償授權 |
顯示於系所單位: | 公共衛生碩士學位學程 |
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