金黃色葡萄球菌院內血流感染分析

　　　　　南部某醫學中心 1998 年 共114 人，計 116 人次金黃色葡萄球菌血流感染個案，以回溯性分析臨床各項資料，並比較感染抗 cxacillin 金黃色葡萄球菌 (oxaoillin-resistant Staphylococcus aureus，ORSA) 與 oxacillin敏感性金黃色葡萄球菌 (oxacillin-susceptible S.aureus，OSSA)之危險因子。結果發現，ORSA 67 人次，OSSA 49 人次，男性 69 人次，女性 47人次，平均年齡62歲。金黃色葡萄球菌血流感染死亡率為 63％。在普通病房感染者有 81 人次，加護病房有 35 人次。感染病患中 60 人次曾經住過加護病房。原發性疾病以腎臟末期疾病 49 人次最多。臨床症狀分析，98 人次屬於原發性金黃色葡萄球菌血流感染， 18 人次屬於續發性感染。在醫療處置方面，放置中心靜脈導管、留置導尿管、氣管內插管、呼吸器及鼻胃管較多，而且是 ORSA 血流感染的危險因子。另外，長期住院及加護病房治療也是 ORSA 血流感染的危險因子。故儘早移除不必要之導管、減少住院天數，及儘可能避免住進加護病房，應有助於降低院內 ORSA 血流感染。(感控雜誌2000；10:94-101)
　　　　　One hundred sixteen episodes of nosocomial Staphylococcus aureus bloodstream infection that occurred at a medical center in southern Taiwan in 1998 were retrospectively analyzed. Those caused by oxacillin-resistant S. aureus (ORSA) and by oxaciilin-susceptible S. aureus (OSSA) were 67 and 49 cases, respectively. The mean age of the patients was 62 years. The crude mortality rate was 63%. Eighty-one episodes developed in regular wards while 35 were found in Intensive Care Units (ICU). Of all 116 cases, 60 had been in ICU al least once. Those considered to be primary or secondary bacteremia were 98 and 18 cases, respectively. Of the invasive procedures carried out for these patients, mechanical ventilatory support and insertion of central venous catheter, Foley catheter, enodotracheal tube and naso-gastric tube were the most frequently seen. Employing Chi-square test, these invasive therapeutic measures, prolonged hospitalization and the admission to the ICU were found to be risk factors for the ORSA, but not the OSSA, bacteremia. Early discontinuation of invasive procedures, shortening of the hospitalization, and the avoidance of ICU admission should help minimize ORSA bloodstream infection. (Nosocom Infect Control J 2000; 10: 94-101)