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題 名 | Clinical Characteristics in Adult Patients with Bacteremia in The Emergency Department=急診菌血症病患之臨床特性 |
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作 者 | 許文祥; 廖美禎; 廖浩欽; 鄧允武; 廖訓禎; | 書刊名 | 臺灣急診醫學會醫誌 |
卷 期 | 8:3 民95.09 |
頁 次 | 頁83-88 |
分類號 | 415.27 |
關鍵詞 | 急診部; 菌血症; 臨床特性; 死亡預測因子; Bacteremia; Emergency department; Clinical features; Mortality factors; |
語 文 | 英文(English) |
中文摘要 | 目的:探討急診菌血症患者之臨床表徵、細菌學及預後。方法:研究設計以醫院為基礎之回顧性調查;時間自2005年1月至2005年12月,對象為所有至急診求診之菌血症患者。結果:研究期間從280位菌血症患者分離出286株細菌;男性120位,女性160位;平均年齡64.6±18歲。臨床表現為敗血症者佔48.2%,嚴重敗血症者25.7%及敗血性休克者5.4%。最常見初步診斷為泌尿道感染佔36.4%、其次不明原因發燒31.4%及呼吸道感染19.3%。而最常見之致病菌為格革蘭氏陰性桿菌73%;其中依序為大腸桿菌、葡萄球菌、克雷白氏肺炎桿菌、鏈球菌及沙門氏桿菌。接受不適當抗生素治療者佔50.4%。接受住院治療者佔75.8%;死亡率9%,具臨床統計意義之死亡預測因子為年長者(P=0.01)、心臟病患者(P=0.02)、帶狀白血球增多症(p=0.01)、貧血(p=0.05)、不適當抗生素使用者(p<0.01)及急性呼吸衰竭(p<0.001)。結論:此研究報告有助瞭解急診菌血症患者臨床特性及死亡預測因子。提升適當抗生素使用仍是重要議題。此外,若臨床上有疑似菌血症患者併有預後不佳之因子時,更應給予積極治療以降低其死亡率。 |
英文摘要 | Objective: The aim of this study was to determine the clinical features, bacteriology, and outcomes of patients with bacteremia in the emergency department. Methods: We performed a retrospective analysis of adult bacteremia patients admitted to the emergency department at Li-Shin Hospital in northern Taiwan from January 2005 through December 2005. Demographic data, clinical features, empiric antibiotic prescriptions and outcomes were collected for analysis. Results: During the study period, 54565 adult patients visited the emergency department. The incidence of bacteremia was approximately 0.5%. A total of 286 microorganism strains were isolated from 280 patients. There were 120 men and 160 women. The mean age was 64.6±18 years (range, 17-102 years). The clinical manifestations included sepsis in 133 patients (48.2%), severe sepsis in 72 patients (25.7%), and septic shock in 15 patients (5.4%). The most common diagnosis was urinary tract infection (36.4%), followed by fever of undetermined source (31.4%), and respiratory tract infection (19.3%). Gram-negative microorganisms were isolated in 209 isolates (73%). The most commonly isolated microorganism was Escherichia coli (42.6%), followed by Staphylococcus species (13.7%), Klebsiella pneumoniae (13%), Streptococcus species (7.7%), and Salmonella species (5.6%). One hundred and forty-one patients (50.4%) received empirically inadequate antibiotic treatment. A total of 212 patients (75.8%) were admitted, among whom, 19 patients (9%) died. The significant independent risk factors for death of the admitted patients were advanced age (p=0.01), underlying heart disease (p=0.02), bandemia (p=0.01), anemia (p=0.05), inadequate antibiotic treatment (p<0.01), and complicated acute respiratory failure (p<0.001). Conclusion: The results of this study emphasize the clinical characteristics of patients with bacteremia and highlights the independent prognostic factors of admitted patients in the emergency department. Elevation of adequate of antibiotics use is an important issue. In addition, in a patient suggested of having bacteremia with high mortality risk factors, emergency department physicians should pay particular attention and utilize more aggressive treatment strategies in an effort to lower the mortality rate. |
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