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研究生:廖儀依
研究生(外文):Liao, Yi-Yi
論文名稱:高齡族群住院病人醫療照護相關感染之危險因子
論文名稱(外文):Risk factors of Healthcare-Associated Infections among hospitalized elderly patients
指導教授:陳律言陳律言引用關係
指導教授(外文):Chen, Lu-Yen
口試委員:張念慈陳瑛瑛
口試委員(外文):Chang, Nien-TzuChen, Yi-Yi
口試日期:2023-5-31
學位類別:碩士
校院名稱:國立陽明交通大學
系所名稱:臨床護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2023
畢業學年度:111
語文別:中文
論文頁數:94
中文關鍵詞:高齡醫療照護相關感染多重抗藥性菌存活分析
外文關鍵詞:ElderlyHealthcare-Associated InfectionsMDROsSurvival Analysis
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背景:我國推估至2025年即邁向超高齡社會,而在醫院的環境中,高齡者相較年輕者更易額外衍生醫療照護相關感染 (Healthcare-associated infection;簡稱HAI)的風險。本研究以疾管署在2018年1月公告實施新版定義監測探討高齡族群醫療護相關感染流行病學、多重抗藥性 (Multidrug-Resistant Organisms,簡稱MDROs) 危險因子及比較感染部位死亡預測因子。
研究方法:本研究為回溯性研究,分析某醫學中心2018年1月至2020年12月入院超過2日之65歲以上(含)病人,且為2018年疾病管制署公告之新版監測定義判定的個案。研究結果以統計套裝軟體IBM SPSS Statistics 24.0版進行資料分析,包括描述性統計、卡方檢定、邏輯式迴歸及存活分析。
結果:研究期間共322,037人住院,其中65歲(含)以上的族群共有5,276人次發生HAI,研究分析顯示住院高齡族群感染部位以血流感染1336人次(31.8% )最多。革蘭氏陰性菌為最常造成血流、尿路及呼吸道感染的分離菌種。抗藥性菌以A.baumannii分離167株中對Carbapenem類有抗藥性佔53.9%最高。
MDROs感染的個案影響因子,包含感染當日APACHE II (Acute Physiology and Chronic Health Disease Classification System II,簡稱APACHE II) 每增加1分、感染前住院天數多增加1天,即增加1%發生MDROs風險。
醫療照護相關肺炎感染病人每增加1歲,增加1.01倍死亡風險、感染當日APACHE II分數每增加1分,死亡風險即上升1.08倍,罹患惡性腫瘤病人較非惡性腫瘤病人增加1.50倍的死亡機率。醫療照護相關血流感染病人Cox分析顯示內科及加護病房病人死亡風險增加2.70-2.78倍,惡性腫瘤史病人增加1.48倍。
討論:具惡性腫瘤史、醫療照護相關血流或肺炎感染的病人增加1-3倍的死亡風險,未來可進一步針對此類族群探討,以減少高齡族群在住院期間發生醫療照護相關感染的機率,避免感染事件的發生導致後續醫療資源的耗用。
Background: Elderlies are more at risk of Healthcare-associated infection (HAI) than younger people. This study explored the epidemiology of medical care-associated infection, multidrug-resistant organisms (MDROs) risk factors and mortality predictors in the elderly population.
Methods: This study is a retrospective study, analyzing patients over 65 years old (inclusive) who were admitted to the hospital for more than 2 days in a medical center from January 2018 to December 2020, and were determined by the new surveillance definition announced by the Centers for Disease Control and Prevention in 2018. The research results were analyzed with the statistical package software IBM SPSS Statistics version 24.0, including descriptive statistics, chi-square test, logistic regression and survival analysis.
Result: During the study period, a total of 5,276 people aged 65 and over had HAI, and the analysis showed that 31.8% suffered from bloodstream infections. Among all the drug-resistant bacteria type, Carbapenem resistance A.baumannii accounted for 53.9% of the drug-resistant infection .
The factors that had impact on MDROs infection included Acute Physiology and Chronic Health Disease Classification System II (APACHE II) on the day of infection, for every 1 point increase and the number of days of hospitalization before infection increased by 1 day, the risk of MDROs increased 1%.
As for patients with HAI pneumonia infection, the age increase 1-year-old indicating an increase of risk of death by 1.01 times. Moreover, the APACHE II score on the day of infection increased by 1 point, the risk of death increased 1.08 times, while the risk of death for patients with malignant tumors increased 1.50 times compared with patients without malignant tumors. Cox analysis of patients with HAI bloodstream infection showed that the risk of death in paitients staying in the internal medicine and intensive care unit had increased 2.70-2.78 times. Similarly, the risk of death for patients with a history of malignant tumors increased 1.48 times.
Conclusions: The result of analysis showed that patients with a history of malignant tumors, medical care-associated blood flow, or pneumonia infection would increase 1-3 times risk of death. How to reduce the incidence of HAI during hospitalization for the elderly and avoid infection should be future explored in the future stud.
中文摘要 i
英文摘要 ii
目錄 iii
圖目錄 iv
表目錄 v
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 6
第三節 研究問題 7
第二章 文獻探討 8
第一節 高齡族群醫療照護相關感染之盛行率與預後 10
第二節 醫療照護相關感染分離菌種及抗藥性菌分佈 14
第三節 住院高齡族群醫療照護相關感染之影響因子 17
第三章 研究方法與設計 20
第一節 研究設計與對象 21
第二節 名詞界定 23
第三節 資料處理及統計分析方法 27
第四節 研究倫理考量 31
第四章 研究結果 32
第一節 住院高齡族群醫療照護相關感染資料分析 32
第二節 住院高齡族群醫療照護相關感染與MDROs分析 45
第三節 比較住院高齡族群醫療照護相關各部位感染與死亡預測因子 51
第五章 討論 64
第一節 住院高齡族群醫療照護相關感染情形 64
第二節 住院高齡族群MDRO醫療照護相關感染與危險因子 66
第三節 住院高齡族群醫療照護相關感染死亡情形及危險因子 68
第六章 結論與建議 72
第一節 結論 72
第二節 研究限制 73
第三節 未來研究與臨床應用 75
參考文獻 76
附錄 90
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