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

Abstract

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.