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題名 | 某醫學中心近五年來燒傷加護病房院內感染之分析=Analysis of Nosocomial Infections at a Burn Intensive Care Unit in Recent Five Years |
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作者 | 李怡慧; 黃高彬; 蔡季君; 黃英絹; 林春珠; 吳淑卉; 陳彥旭; 陳田柏; | 書刊名 | 院內感染控制雜誌 |
卷期 | 7:2 1997.04[民86.04] |
頁次 | 頁77-84 |
分類號 | 419.38 |
關鍵詞 | 燒傷加護病房; 院內感染菌種; 死亡率; 抗藥性; Burn intensive care unit; Nosocomial infection pathogens; Mortality rate; Antimicrobial resistance; |
語文 | 中文(Chinese) |
中文摘要 | 燒傷病人是屬於院內感染的高危險群,感染通常是燒傷病人致死的主要原因,而最普遍的感染部位是燒傷傷口及肺部。本研究的目的乃是探討高醫近五年來(1992年1月至1996年12月)傷燒病人,其院內感染菌種、感染部位、燒傷傷口類別與合併症、死亡率之關係。這五年來燒燒加護病房共有189個感染人次,年感染率介於16.0%∼79.6%之間,分離出的院內感染菌種,革蘭氏陽性菌佔23.6%,革蘭氏陰性菌佔76.4%,以Pseudomonas aeruginosa(38.8%)最多,依次是Staphylococcus aureus(16.3%)、Klebsiella pneumoniae (9.6%)、Escherichia coli(7.9%)、Enterbacter cloacae(4.5%)。在部位感染率方面,以傷口感染(15.1%)佔最高的比例,依次為呼吸道感染(5.7%),血流感染(4.2%),其他部位感染(3.5%)和尿路感染(3.2%)。燒傷傷口感染菌種,革蘭氏陽性菌佔16.7%,革蘭氏陰性菌佔83.3%,革蘭氏陰性菌中P. aeruginosa則高達53.3%。重度燒傷病人傷口感染率是46.0%,其合併症以呼吸道感染最多(43.4%),其次為血流感染(25.3%),死亡率為34.6%,死亡原因有敗血症和呼吸衰竭等。在抗藥性方面,ORSA vancomycin具感受性,Enterococcus只對ampicillin vancomycin不具抗藥性。P. aeruginosa對ciprofloxacin之感受性較佳,對aminoglcoside和第二代及第三代cephalosporin類藥物抗藥性強。燒傷傷口感染P. aeruginosa 在本研究調查發現所佔的比例非常高(53.3%),所以如何有效降低燒傷傷口感染,是燒傷加護病房院內感染防治上最重要的課題。 |
英文摘要 | Burn patients are among those a higest risk or hospital-acquired infections. It is the most common cause of death in those patients, and the most frequent sites of infections are the burn wounds and the lungs. We analyzed retrospectively at our burn intensive care unit from January, 1992 to September, 1996. There were 189 nosocomial infections in 79 patients. The average annual infection rate varied form 16.0% to 79.6%. Gram-positive bacteria accounted for 23.6%, and the gram-negative 76.4%. Pseudemonus aeruginosa was the predominant pathogen(38.8%), and the other major noes were Staphylococcus aureus(16.3%), Klebsiella pneumoniae (9.6%), Escherichia coli (7.9%) and Enterobacter cloacae(4.5%). Infection sites were wounds (15.1%), respiratory tract(5.7%), blood stream (4.2%), urinary tract (3.2%), and others (3.5%). In patients with severe burn injury, the wound infection rate was 46.0%, and the respiratory tract infection 43.4%, the overall mortality was 34.6%. Antimicrobial resistance of the pathogens was prevalent among those bacterial isolates. Oxacillin-resistant s. aureus and Enterococcus were prevalent among those bacterial isolates. Oxacillin-resistant S. aureus and enterococcus were susceptible to vancomycin only, and the P. aeruginosa susceptible to ciprofloxacin while resistant to aminoglycosides, and the second and third generation cephalosporins. |
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