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題名 | 成人院內念珠菌血流感染流行病學特徵之分析=An Analysis of Nosocomial Candidemia among Hospitalized Adult Patients |
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作者 | 吳淑萍; 黃樹樺; 黃高彬; 盧柏樑; 蔡季君; 李怡慧; 林春珠; 吳淑卉; | 書刊名 | 院內感染控制雜誌 |
卷期 | 12:6 2002.12[民91.12] |
頁次 | 頁355-365 |
分類號 | 419.38 |
關鍵詞 | 院內念珠菌血症; 危險因子; Nosocomial candidemia; Risk factor; |
語文 | 中文(Chinese) |
中文摘要 | 為了解本院院內念珠菌血症感染病患的致病因素、臨床表現、抗生素使用與預後,我們回溯式統計 1998 年 1 月至 2000 年 9 月期間109位院內念珠菌血症感染患者資料,結果發現感染發生率為 1.32?。感染個案較常發生在加護病房,感染發生率是一般病房的 10.7倍,男女性別無差異,平均年齡 61.9±15.9歲 (中位數64)。感染前之住院天數 43.7±71.5天 (中位數25天),總平均住院天數是全院平均住院天數的 5.13倍。以個案原發性疾病來分,血液睡瘤疾病佔最多,其次為腸胃道疾與糖尿病。感染前接受侵入性的醫療措施以中央靜脈導管、導尿管、呼吸器為最多,有 82,6% 的個案在感染前曾使用三種以上抗生素,45.0%的個案使用 H2-blocker。最常見的致病菌為 C. albicans 其次是 C.tropicalis、C. parapsilosis 和 C. intermedia,臨床表現多呈現高燒 (?38。C)、敗血症與敗血性休克且實驗室數據異常如:CRP?6ug/mL、albumin<3.0g/dL、leuKocytosis>104/mm3。109位感染個案有 86 位接受抗黴菌劑治療,死亡率 40.4%。分析危險因子與死亡率之相關性,只有年老者(66.16±14.75歲)、血液腫瘤疾病患者、白蛋白低下者和發病時出現敗血性休克現象等,均具有統計上之意義。進一步以邏輯回歸分析念珠菌與危險因子關係,只有 C. parapsilosis 與腹部手術具有統計上之意義(OR=5.65,p=0.013)。(感控雜誌2002;12:355-65) |
英文摘要 | A retrospective study was performed to investigate predisposing factors, clinical manifestations, and prognosis of adult patients with nosocomial candidemia at Kaohsiung Medical University Hospital, from January, 1998, till September, 2000. There was a total of 109 patients with the infection, with the prevalence of 1.32 per 1,000 discharges. The average age of patients was 61.9 ± 15.9 years (median 64). There was no difference between the incidences in the male and the female. The infection was 9.6 times more common in the intensive care units than in the regular wards (7.59% vs. 0.79%; p <0.001). Pre-infection hospital stay was 43.7 ± 71.5 days (median 25), and the total hospital stay was 5-6 time longer than that of the average patients (82.1 ± 128 days vs. 14 ± 16 days; p<0.001). The infected cases had underlying haemato-oncologic diseases (47.7%), gastrointestinal diseases (38.5%), or diabetes mellitus (34.7%). The 3 most common invasive procedures applied during the pre-infection admission periods were the insertion of indwelling central venous catheters (76.1%), Foley catheters (66. 1%), and endotracheal tubes (52.3%). During the same period, 82.6% were given more than 3 kinds of antibiotics, and 45% given H2 blockers. The most common pathogen was Candida albicans (43%), followed by C. tropicaIis (20%), C. parapsilosis (7.3 %), and C. intermedia (6.4%). Antifungal agents were given to 86 patients to treat the infection. The mortality rate was 40.4%. The significant risk factors (p<0.05) included the old age (66.16 ± 14.75 years), underlying haemato-onco- logic diseases, cachexia, and septic shock. (Nosoeom Infect Control d 2002; 12:355-65) |
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