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| 題 名 | Outcome Analysis of Patients Requiring Mechanical Ventilation with Severe Community-Acquired Pneumonia and Identified Bacterial Pathogens=需使用呼吸器的嚴重社區型肺炎之致病菌及預後分析 |
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| 作 者 | 胡漢忠; 黃崇旂; 蔡熒煌; 李政輝; 謝孟哲; | 書刊名 | 長庚醫學 |
| 卷 期 | 28:4 2005.04[民94.04] |
| 頁 次 | 頁229-236 |
| 分類號 | 415.463 |
| 關鍵詞 | 嚴重社區型肺炎; 格蘭氏陰性桿菌; Severe community-acquired pneumonia; Gram-negative bacilli; APACHE Ⅱ.; |
| 語 文 | 英文(English) |
| 中文摘要 | 背景:肺炎至目前為止,仍然是重要且致命的感染性疾病,嚴重社區型肺炎的死亡率更高。治療上一般以廣效性抗生素為主,再根據細菌培養結果更改藥物。本研究之目的在於分析本區的細菌分布,以作為抗生素選擇的參考,並分析這群病患死亡之危險因子。 方法:我們收集2001年1月至2001年12月間因嚴重社區型肺炎而插管送進北臺灣某醫學中心內科加護病房的患者。我們回顧他們的醫療紀錄,其中59位細菌培養有結果,比較存活者和死亡者和死亡者的年齡,住院時APACHE II分數及PaO2/FiO2比值的差異。 結果:59位病患(48位男性,11位女性),平均年齡為67.7±16.3歲。培養的細菌中以克雷白氏菌最多(佔21.3%),其次為綠膿桿菌(佔17.3)。在格蘭氏陽性細菌中以金黃色葡萄球菌最多(佔8%)。此群患者之平均死亡率為55.9%。經由多變項邏輯斯締迴歸(multiple logistic regression)分析,年齡大於75歲以及APACHE II大於23者有顯著較高的風險比。 結論:格蘭氏陰性桿菌在需使用呼吸器的嚴重社區型肺炎為重要的致病菌。我們在抗生素的選擇上,應使用更廣泛、更強效的藥物,有時甚至要用到抗綠膿桿菌類的抗生素或Carbapenem類之樂物。若格蘭氏陽性菌出現時,要小心抗Oxacililine類之金黃色葡萄球菌。在整個治療過程中,年齡及APACHE II分數高者有較高的死亡率。 |
| 英文摘要 | Background: Severe community-acquired pneumonia (CAP) is associated with high mortality. The choice of antibiotics should be guided by the sitribution of bacterial pathogens. The purpose of this study was to analyze the causative bacteria and outcomes of patients with severe CAP in a medical intensive care unit (MICU) in Taiwan. The results may provide a basis of guidance for future empirical antibiotic treatments. Methods: We enrolled patients with severe CAP who were intubated and who required mechanical ventilation in a MICU in 2001. Only patients with identified bacterial pathogens were included. The bacterial distribution was determined, while differences in age, acute physiology and chronic health evaluation (APACHE) II scores, and initial PaO2/FiO2 ratio between surviving and expired patients were compared. Results: Fifty-nine patients were enrolled and 75 isolates were obtained. Klebsiella pneumoniae was the most common bacteria (21.3%), followed by Pseudomonas aeruginosa and Acinetobacter baumannii. Staphylococcus aureus (8%) was the most-commonly isolated gram-positive organism, and half of its isolates were oxacillin-resistant (ORSA). The overall mortality was 55.9%. Multiple logistic regression analysis revealed that survivors had a significantly younger age and lower APACHE II scores. Conclusions: Gram-negative bacillia were the most-common causative pathogens among patients with severe CAP requiring mechanical ventilation. Antipseudomonal antibiotics or a carbapenem should be considered to cover Pseudomonas species, extended-spectrum β-lactamase-producing strains, and Acinetobacter species. If the isolated bacteria are gram-positive, care should be taken to cover the possibility of ORSA. Old age and higher APACHE II scores were associated with higher mortality. |
本系統中英文摘要資訊取自各篇刊載內容。