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頁籤選單縮合
題 名 | Predictors of Hospital Mortality in Adult Patients with Community-Acquired Bloodstream Infection in the Emergency Room=急診室菌血症患者住院中死亡之預測因子 |
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作 者 | 陳宗銘; 蔡宗華; 陳芳志; 詹賜貳; | 書刊名 | 中華民國急救加護醫學會雜誌 |
卷 期 | 18:3 2007.09[民96.09] |
頁 次 | 頁93-109 |
分類號 | 415.27 |
關鍵詞 | 菌血症; 急診; Bloodstream infections; BSI; Emergency room; ER; Community; |
語 文 | 英文(English) |
中文摘要 | 背景:到目前為止,菌血症的患者死亡率仍頗高,但是如何從急診室中的一些臨床指標來預測菌血症患者之住院死亡率的前瞻性研究並不多。 目標:由病人之基本條件,臨床表現以及細菌學等因子來探討急診室菌血症患者住院中死亡與否及上述因子間的關聯。 方法:自2005年1月1日到同年12月31日,為期一年的前瞻性研究。所有彰化基督教醫院二林分院的急診患者中;大於十八歲且於急診室中收集的血液培養為陽性的病人均納入研究分析。病人的基本資料,原本之疾病,臨床的表現,微生物學,感染的來源,抗生素的敏感試驗結果,經驗性抗生素的使用種類,以及住院預後等均加以收集分析,並以迴歸統計來測試這些因子對病患預後的預測值。 結果:共有90個病例納入本研究,平均年齡70.1歲,其中51個為女性。最常見的原本疾病為糖尿病 (42%),神經性疾患且長期臥床 (24.4%),心血管疾病(21.1%),肝硬化 (15.5%),以及癌症 (12.2%)。最常見的致病菌為 E.coli (47.8%),Klebsiella屬 (10%),及 Staphylococcus aureus (7.7%)。最常見的感染來源為泌尿道 (47.8%),或腹腔內感染 (22.2%)。有 32% 的病例在急診中即發現有急性器官功能不全或休克,接受有效的經驗抗生素治療的患者佔 82.2%。住院中死亡率為 15.5%。迴歸分析顯示出原本有肝硬化的患者 (OR 6.37,P=0.005),於急診即符合嚴重敗血症或敗血性休克條件的患者 (OR 44.68,P<0.001),以及感染來源為肺炎 (OR 42,P=0.004)或為腹內感染 (OR 34.36,P=0.001),均可作為預測住院中死亡的指標。 結論:某些因子可作為急診室中預測菌血症患者的住院預後指標。 |
英文摘要 | Background: Bloodstream infections (BSI) continue to be a serious problem in the community, but data on the clinical predictors of hospital mortality associated with BSI patients presenting in the emergency department are limited in Taiwan. Objectives: To characterize the clinical and microbiological factors for hospital mortality fromcommunity-acquired BSI in emergency room (ER) patients. Methods: This 12-month prospective study was conducted at the Erlin branch of Changhua ChristianHospital from January 1, 2005 to December 31, 2005. All admitted patients over 18 years old with microbiologically confirmed BSI in the ER were enrolled. Data were collected on demographics, comorbid medical conditions, clinical profile, microorganisms, source of infection, antimicrobial susceptibility testing, empiric antibiotic therapy, and hospital outcome. The prognostic factors were studied using univariate logistic regression. Results: During the study period, a total of 90 cases of BSI were reported. The mean age of thepatients was 70.1 years (range, 39 to 97 years), and 51 (56.6%) patients were women. The most common comorbidities were diabetes mellitus (42.2%), neurological disorder with poor performance (24.4%), cardiovascular disease (21.1%), liver cirrhosis (15.5%), and underlying malignancy (12.2%). The most common pathogens were Escherichia coli (49%), Klebsiella species (8.8%), and taphylococcusaureus (7.8%). The most common sources of BSI were the urinary tract (47.8%), and intra-abdominal sites (22.2%). Abnormal body temperature was the most frequent clinical finding (85.5%), and 32% of the patients developed acute organ dysfunction in the ER. Appropriate empiric antibiotic therapy was administrated in 82.2% of the cases. The hospital mortality rate was 15.5%. Univariate analysis revealedthe predictors of mortality were comorbid liver cirrhosis (OR 6.37, p=0.005), presence of severe sepsis or septic shock (OR 44.68, p<0.001), and pneumonia (OR 42, p=0.004) or an intra-abdominal site (OR34.36, p=0.001) as the source of infection. Conclusions: The predictors identified in this study provide important prognostic information for patients with community-acquired BSI on arrival in the ER. |
本系統中英文摘要資訊取自各篇刊載內容。