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題 名 | Prevalence of Nosocomial Respiratory Tract Infections in the Surgical Intensive Care Units of a Modical Center=某醫學中心外科加護病房院內呼吸道感染之狀況 |
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作 者 | 王復德; 陳瑛瑛; 劉正義; | 書刊名 | 中華醫學雜誌 |
卷 期 | 61:10 1998.10[民87.10] |
頁 次 | 頁589-595 |
分類號 | 419.38 |
關鍵詞 | 院內呼吸道感染; 外科加護病房; Nosocomial respiratory tract infections; Intensive care unit; |
語 文 | 英文(English) |
中文摘要 | 背景 加護病房是院內呼吸道感染最常見的地方之一。本研究之目的是了解台灣 醫學中心不同性質成人外科加護病房之院內呼吸道感染的發生率、分佈及菌種變遷等情況, 以提供臨床醫療人員在照護患者時作參考。 方法 以 1991 至 1996 年入住臺灣某醫學中心外科、心臟外科及神經外科加護病房 72 小 時以上,發生院內呼吸道感染之患者為對象,由感染管制護理師每週例行到病房,進行以患 者為基準的全面性調查。資料經描述性及推理性統計分析。 結果 院內呼吸道感染共 277 人次,平均感染率為每千住院人數每日 3.8 次,以神經外科 加護病房感染次數最多( 160 人次),在統計學上有顯著差異( p < 0.01 )。患者總住 院天數為 61 天(中位數);感染發生在住院後 19 天(中位數);感染後的住院天數為 38 天(中位數)。 呼吸道感染中又以肺炎佔的比例最高( 91.3% )。總死亡率為 42.6%, 其中以外科加護病房的死亡人數最多( 56/91 人次), 與其它二個加護病房比較有顯著差 異( p < 0.01 )。 大部份的院內呼吸道感染患者使用侵入性導管或裝置, 如鼻胃管 221 例( 79.8 % ),氣管內管 201 例( 72.6% ),呼吸器 18 例( 67.5 % )。 總共分 離出 297 種菌株, 以 Pseudomonas aeruginosa 最多( 29.6% ), Staphylococcus aureus 次之( 26.6% ),其中 methicillin-resistant S aureus ( MRSA )高達 88.2% 。 結論 神經外科護病房院內呼吸道感染比心臟外科及外科加護病房多,大部份患者均使用侵 入性導管或裝置。而 S aureus 在院內致病菌株中逐漸扮演著重要的角色,尤其是 MRSA 應 列為防治之重點。 |
英文摘要 | Background. The intensive care unit (ICU) is one of the most common locations in the hospital for the development of nosocomial respiratory tract infections (PTIs) . The purpose of this study was to better understand and compare the rate of nosocomial RTIs, their distribution and the frequency of infective organisms in three different adult surgical ICUs at a medical center in Taiwan. Methods. This retrospective study covered the period from 1991 to 1996, and targeted patients who had acquired nosocomial RTIs more than 72 hours after admission to the surgical, cardiovascular surgical, or neurosurgical ICU. Infection control nurses made routine weekly rounds to the units and conducted comprehensive patient-based surveys.Data collected were subjected to descriptive and deductive statistical analyses. Results. A total of 277 episodes of nosocomial RTIs were encountered (3.8 episodes per 1,000 patient-days of hospitalization). Neurosurgical ICU patients had the highest infection rate (4.8%) (p<0.01). The median length of hospital stay of patients acquiring nosocomial RTIs was 61 days; the infection occurred 19 days (median) after admission to the ICU and the length of postinfection stay was 38 days (median). Pneumonia accounted for 91.3% of these infections. The overall mortality rate was 42.6%, with the surgical ICU having the highest mortality rate (61.5%), which was significantly higher compared with the other two ICUs studied. The majority of patients with nosocomial RTIs had medical catheters or devices in place. A total of 297 isloates were cultured from 277 infected patients. Pseudomonas aeruginosa was the predominant organism isolated (29.6%), followed by Staphylococcus aureus (26.6%), of which 88.2% were methicillin-resistant S aureus (MRSA). Conclusions. The rate of nosocomial RTIs was significantly higher in neurosurgical ICU patients; the majority of infected patients had medical catheters or devices in place. S aureus played an increasingly important role as a nosocomial pathogen; hence, control of MRSA should be the focus of infection control policies. |
本系統中英文摘要資訊取自各篇刊載內容。