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系統識別號 U0026-0812200915402181
論文名稱(中文) 探討某醫學中心加護單位萬古黴素抗藥性腸球菌 移生之危險因子 - 病例對照研究
論文名稱(英文) Risk factors of Vancomycin-Resistant Enterococcus Colonization at Intensive Care Units of a Medical Center : Case Control Study
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 97
學期 2
出版年 98
研究生(中文) 邱燕玲
研究生(英文) Yen-ling Chiu
學號 t2691102
學位類別 碩士
語文別 中文
論文頁數 44頁
口試委員 口試委員-柯文謙
口試委員-柯乃熒
指導教授-王琪珍
中文關鍵字 病例對照研究  移生  萬古黴素抗藥性腸球菌 
英文關鍵字 Vancomycin-resistant enterococcus  Colonization  Case control study 
學科別分類
中文摘要 本病例對照研究乃探討南部某醫學中心2005年11月至2006年3月間 發生萬古黴素抗藥性腸球菌(VRE)移生事件之相關危險因子,以1:2病例對照配對方式,共選取102名研究對象,透過病歷紀錄以收集相關資料,如慢性病數、疾病嚴重度、近三個月住院(機構)史、腹部手術否、住院單位、加護單位停留天數、抗生素使用狀況(含種類與天數、使用Vancomycin、第三代頭孢子素、Metronidazole等)。以相對危險對比值(Odd’s Ratio, OR)描述各變項與VRE之關聯性,進一步以邏輯複迴歸分析確認VRE移生事件之相關危險因子,結果發現,研究對象中若有「抗生素使用≥3種」及「抗生素使用天數≥7天」之情形者,出現VRE移生事件的危險性是沒有這樣使用抗生素者的5.8倍及4.5倍。故建議若成人加護單位患者當使用抗生素種類超過三種,且使用天數長達七天以上,可主動篩檢其是否有VRE移生發生,以及早發現病人是否為VRE移生帶原者,避免病人本身發生感染的機會,也避免單位其他病人或環境發生移生的可能。
英文摘要 The aim of this case-control study was to explore the risk factors of Vancomycin-resistant enterococcus (VRE) colonization in a medical center of southern Taiwan. The ratio of 1:2, with one case to two controls, was applied in regard to the samples. A total of 102 patient subjects were included from intensive care units during the four month period from Nov. 2005 to Mar. 2006. There were 34 patients with VRE colonization, after the lab had identified and matched a selected 68 patients without VRE colonization as control, from the same ward. Information was then collected, such as on: co-morbidity, morbidity severity assessment with APARCH II score, experience of hospitalization or institutionalization during the recent 3 months, having undergone an abdominal operation, length of ICU stay, multi-class of antimicrobial usage, and length of antibiotic usage, by chart review. The Odd’s Ratio (OR) was applied to describe the risk of VRE colonization and multiple logistic regression analysis was used to determine risk factors in advance. The results show the risk of 5.8 times and 4.5 times regarding VRE colonization in using an antimicrobial with more than 3 classes and over 7 days in length to compare with fewer than 3 categories and under 7 days in antimicrobial usage, respectively. According to the study results, we suggest that when patients use antimicrobial with more than 3 classes or more than 7 days they should be actively screened for early detection to prevent a VRE colonization outbreak among intensive care units patients.
論文目次 目錄 I
圖目錄 II
表目錄 III
中文摘要 IV
英文摘要 V
致謝 VI
第一章 緒論 1
第一節 研究重要性 1
第二節 研究目的 3
第二章 文獻查證 4
第一節 萬古黴素抗藥性腸球菌 4
第二節 VRE與院內感染管制 7
第三節 萬古黴素抗藥性腸球菌的相關研究 11
第四節 病例對照研究法 14
第三章 研究方法 15
第一節 VRE移生事件脈絡之回溯 15
第二節 研究設計 16
第三節 名詞解釋 19
第四章 研究結果 20
第一節 病例組及對照組病人特徵 20
第二節 VRE移生的單因子危險估計 22
第三節 VRE移生的邏輯複回歸分析 24
第五章 討論 25
第六章 結論與建議 29
第一節 結論 29
第二節 研究限制 30
參考文獻 31
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