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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(Chi-Tai Fang) | |
dc.contributor.author | Chun-Chun Yeh | en |
dc.contributor.author | 葉竹君 | zh_TW |
dc.date.accessioned | 2021-06-17T08:41:03Z | - |
dc.date.available | 2019-08-26 | |
dc.date.copyright | 2019-08-26 | |
dc.date.issued | 2019 | |
dc.date.submitted | 2019-08-07 | |
dc.identifier.citation | 1.Mainul Haque, M. S., Judy McKimm, Muhamad Abu Bakar. (2018). Health care-associated infections – an overview. Infect Drug Resist, 22, 2321–2333.
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'Clinical impact of methicillin-resistant Staphylococcus aureus bacteremia based on propensity scores.' Infection 39(2): 141-147. 20.Rubio-Terres, C., et al. (2010). 'Cost of bacteraemia caused by methicillin-resistant vs. methicillin-susceptible Staphylococcus aureus in Spain: a retrospective cohort study.' Clin Microbiol Infect 16(6): 722-728. 21.Ben-David, D., et al. (2009). 'Are there differences in hospital cost between patients with nosocomial methicillin-resistant Staphylococcus aureus bloodstream infection and those with methicillin-susceptible S. aureus bloodstream infection?' Infect Control Hosp Epidemiol 30(5): 453-460. 22.Filice, G. A., et al. (2010). 'Excess costs and utilization associated with methicillin resistance for patients with Staphylococcus aureus infection.' Infect Control Hosp Epidemiol 31(4): 365-373. 23.Cosgrove, S. E., et al. (2003). 'Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis.' Clin Infect Dis 36(1): 53-59. 24.Joo, E. J., Park, D. A., Kang, C. I., Chung, D. R., Song, J H., Lee, S. M., & Peck, K. R. (2018). Reevaluation of the impact of methicillin-resistance on outcomes in patients with Staphylococcus aureus bacteremia and endocarditis. Korean J Intern Med. 25.Merz L.R. et al.(2010). 'Cost of Antimicrobial Resistance in Healthcare Settings: A Critical Review.', Karger 6:102-119 26.Gandra, S., et al. (2014). 'Economic burden of antibiotic resistance: how much do we really know?' Clin Microbiol Infect 20(10): 973-980. 27.Chatterjee, A., Rai, S., Guddattu, V., Mukhopadhyay, C., & Saravu, K. (2018). Is methicillin-resistant Staphylococcus Aureus infection associated with higher mortality and morbidity in hospitalized patients? A cohort study of 551 patients from South Western India. Risk Manag Healthc Policy, 11, 243-250. 28.Simor, A. E., Pelude, L., Golding, G., Fernandes, R., Bryce, E., Frenette, C., . . . Weiss, K. (2016). Determinants of Outcome in Hospitalized Patients With Methicillin-Resistant Staphylococcus aureus Bloodstream Infection: Results From National Surveillance in Canada, 2008-2012. Infect Control Hosp Epidemiol, 37(4), 390-397. 29.Quan, H., Sundararajan, V., Halfon, P., Fong, A., Burnand, B., Luthi, J. C., . . . Ghali, W. A. (2005). Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care, 43(11), 1130-1139. 30.Hsieh, M. S., How, C. K., Hsieh, V. C., & Chen, P. C. (2019). Preadmission Antihypertensive Drug Use and Sepsis Outcome: Impact of Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs). Shock. 31.Wi, Y. M., Rhee, J. Y., Kang, C. I., Chung, D. R., Song, J. H., & Peck, K. R. (2018). Clinical predictors of methicillin-resistance and their impact on mortality associated with Staphylococcus aureus bacteraemia. Epidemiol Infect, 146(10), 1326-1336. 32.Stewardson, A. J., Allignol, A., Beyersmann, J., Graves, N., Schumacher, M., Meyer, R., . . . Harbarth, S. (2016). The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: a multicentre retrospective cohort study. Euro Surveill, 21(33). 33.Wang, J. T., Hsu, L. Y., Lauderdale, T. L., Fan, W. C., & Wang, F. D. (2015). Comparison of Outcomes among Adult Patients with Nosocomial Bacteremia Caused by Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus: A Retrospective Cohort Study. PLoS One, 10(12), e0144710. 34.Chun, J. Y., Seo, H. K., Kim, M. K., Shin, M. J., Kim, S. Y., Kim, M., . . . Kim, H. B. (2016). Impact of a hand hygiene campaign in a tertiary hospital in South Korea on the rate of hospital-onset methicillin-resistant Staphylococcus aureus bacteremia and economic evaluation of the campaign. Am J Infect Control, 44(12), 1486-1491. 35.Marra, A. R., Edmond, M. B., Schweizer, M. L., Ryan, G. W., & Diekema, D. J. (2018). Discontinuing contact precautions for multidrug-resistant organisms: A systematic literature review and meta-analysis. Am J Infect Control, 46(3), 333-340. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/74531 | - |
dc.description.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。 | zh_TW |
dc.description.abstract | 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. | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T08:41:03Z (GMT). No. of bitstreams: 1 ntu-108-R03847022-1.pdf: 1429339 bytes, checksum: fee4e26dd71c5e26b7b6a718c13976cb (MD5) Previous issue date: 2019 | en |
dc.description.tableofcontents | 口試委員會審定書 i
謝 辭 ii 摘 要 iii Abstract iv 目 錄 vi 表目錄 vii 第一章 導論 1 第一節 實習單位特色與簡介 1 第二節 研究背景、動機、目的與研究問題 2 第三節 研究架構與假設 3 第四節 文獻回顧 4 第二章 研究方法 6 第一節 研究設計 6 第二節 分析方法 8 第三章 結果 11 第一節 暴露組(MRSA)與非暴露組(MSSA)基本變項之分布情形 11 第二節 存活分析比較 11 第三節 感染後是否有新申請血液透析重大傷病卡 12 第四節 感染後是否有新申請呼吸器重大傷病卡 12 第四章 結論 13 第一節 討論 13 第二節 研究限制及建議 14 參考文獻 15 附錄一、醫療照護相關感染監測定義 18 附錄二、共病指標評估 20 附錄三、感染部位分類 22 表1、MRSA v.s MSSA基本變項之分布情形 26 表2、Cox Proportional Hazard Model─存活分析 (單變項) 27 表3、Cox Proportional Hazard Model─存活分析 (多變項) 28 表4、Cox Proportional Hazard Model─新申請血液透析重大傷病卡分析 (單變項) 29 表5、Cox Proportional Hazard Model─新申請血液透析重大傷病卡分析 (多變項) 30 表6、Cox Proportional Hazard Model─新申請呼吸器重大傷病卡分析 (單變項) 31 表7、Cox Proportional Hazard Model─新申請呼吸器重大傷病卡分析(多變項) 32 | |
dc.language.iso | zh-TW | |
dc.title | 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 | zh_TW |
dc.title | Mortality, long-term disability, and medical expenditure: methicillin-resistant versus methicillin-sensitive Staphylococcus aureus bacteremia | en |
dc.type | Thesis | |
dc.date.schoolyear | 107-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 謝明順(Ming-Shun Hsieh),盤松青(Sung-Ching Pan) | |
dc.subject.keyword | 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, | zh_TW |
dc.subject.keyword | healthcare-associated infections,bloodstream infection,bacteremia,Staphylococcus aureus,long-term disability,medical expenditure, | en |
dc.relation.page | 32 | |
dc.identifier.doi | 10.6342/NTU201902622 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2019-08-08 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 公共衛生碩士學位學程 | zh_TW |
顯示於系所單位: | 公共衛生碩士學位學程 |
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