從1960年代初期至今，抗藥性金黃色葡萄球菌(methicillin resistant Staphylococcus aureus, MRSA)為北美、歐洲及台灣院內感染的主要致病原，而加護病房被證實為醫院間及醫院內MRSA傳播的主要場域。研究目的為發展類神經網路預測成人加護病房MRSA帶菌病人，依據實驗室診斷結果，比較類神經網路預測MRSA帶菌的敏感性、特異性以及ROC curve，以驗證類神經網路預測MRSA帶菌病人之正確率。採前瞻性研究設計，針對南部某1000床之醫學中心住進成人加護病房區共201位病人進行MRSA帶菌篩檢，且經由鼻腔檢體確立為MRSA帶菌病人，同時收集病人的人口學資料、臨床及實驗室檢驗資料，以作為進行類神經網路預測MRSA帶菌者塑模的訓練資料；將樣本分成100、120、140、160、180筆的訓練資料進行類神經網路的塑模，並且分別使用未放入訓練的資料以進行模式預測力的驗證。結果發現成人加護病房的MRSA帶菌者的盛行率為11.9%。類神經網路預測MRSA帶菌者的敏感性、特異性以及正確率會隨著樣本數的增加而提高；當訓練樣本數從100筆增加到180筆時，其敏感性平均可從32.79%提高至80%以上，且特異性以及正確率可維持在95.5%及97.22%。因此透過使用類神經網路模式塑模來權重MRSA帶菌者的危險因子，以預測成人加護病房的MRSA帶菌者，為有效、即時、快速以及可成為替代主動篩檢的選擇性診斷策略之ㄧ。

Methacillin-resistant Staphylococcus aureus (MRSA) has been recognized as the most important pathogen of nosocomial infections in North America, Europe, and Taiwan. Intensive care units (ICU) play a major role in the spread of MRSA infection in hospitals. This study was developed a trained artificial neural network (ANN) model that accurately predicted the likelihood of MRSA carriages at the time of admission to adult ICUs. Patients who admitted to ICU within 24 hours were screened for nasal MRSA colonization and risk factors associated with MRSA carriages were collected. The laboratory results and collected risk factors were used to train the artificial neural network (ANN) model. Based on the laboratory diagnosis, sensitivity, specificity, accuracy, and ROC curve were used to validate the performances of the ANN models. A total of 201 patients were enrolled. The 201 samples were divided into two data sets for training and validation uses. The 201 samples were randomly selected as 50%, 60%, 70%, 80%, 90% to train the ANN model respectively, and the remaining data were used to validate the performance of the well-trained ANN model by taking the laboratory results as the golden standard for the diagnosis of MRSA colonization.
The prevalence rate of MRSA carriages in adult ICUs is 11.9%. The accuracy of the trained ANN models were enhanced along with the samples increased. When the trained samples were increasing from 100 to 180 samples, the sensitivity was improved from 32.79% to 80% and the specificity and the accuracy reached to 95.5% and 97.22%. The well-trained validated ANN model can predict MRSA carriages accurately and may be an effective, immediate, timely alternative to carry out the active surveillance. Applying the trained ANN model to quickly diagnose and implement efficient infection control programs to reduce the medical costs and nosocomial infections in adult ICUs.

王宗曦、張上淳、陳主慈、楊采菱、施秀、王華恭、周志浩(2006)‧台灣醫學中心及區域醫院2001年-2003年金黃色葡萄球菌之抗藥性情形‧院內感染控制雜誌，16(2)，1－8。
疾病管制局(無日期)‧93年院內感染通報系統監測報告‧2006年4月1日取自http://203.65.72.42/iimdownload/93report.doc
張上淳、蔡佳倫、王振泰、黃高彬、呂學重、莊銀清、王立信、王復德、劉有增、劉清泉、周明淵、王敦正、陳國東(2004)‧台灣醫學中心及區域醫院1999-2002年院內感染之概況‧院內感染控制雜誌，14(1)，1－11。
蘇麗香、趙怜惠、劉建衛、黃英彥(2000)‧金黃色葡萄球菌院內血流感染分析‧院內感染控制雜誌，10(2)，94－101。
Babcock, H. M., Zack, J. E., Garrison, T., Trovillion, E., Jones, M., Fraser, V. J., ＆ Kollef, M.H. (2004). An Educational Intervention to Reduce Ventilator- Associated Pneumonia in an Integrated Health System: A Comparison of Effects. Chest, 125(6), 2224-2231. Retrieved September 9, 2005, from the www.chestjournal.org Online database.
Basheer, I. A., & Hajmeer, M. (2000). Artificial neural networks: fundamentals, computing, design, and application. Journal of Microbiological Methods., 43(1), 3-31.
Baxt, W. G., & Skora, J. (1996). Prospective validation of artificial neural network trained to identify acute myocardial infarction. Lancet, 347(8993), 12-15.
Baxt, W. G., Shofer, F. S., Sites, F. D., & Hollander, J. E. (2002a). A neural computational aid to the diagnosis of acute myocardial infarction. Annals of Emergency Medicine, 39(4), 366-373.
Baxt, W. G., Shofer, F. S., Sites, F. D., & Hollander, J. E. (2002b). A neural network aid for the early diagnosis of cardiac ischemia in patients presenting to the emergency department with chest pain. Annals of Emergency Medicine, 40(6), 575-583.
Batra, R., Eziefula, A. C., Wyncoll, D., & Edgeworth, J. (2008). Throat and rectal swabs may have an important role in MRSA screening of critically ill patients. Intensive Care Medicine.
Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics. (5th ed), New York: Oxford University.
Blot, S. I., Vandewoude, K. H., Hoste, E. A., & Colardyn, F. A. (2002). Outcome and attributable mortality in critically Ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Archives of Internal Medicine, 162(19), 2229-2235.
Boyce, J. M. (2002). Understanding and controlling methicillin-resistant Staphylococcus aureus infections. Infection Control and Hospital Epidemiology, 23(9), 485-487.
Chaix, C., Durand-Zaleski, I., Alberti, C., & Brun-Buisson, C. (1999). Control of endemic methicillin-resistant Staphylococcus aureus: a cost-benefit analysis in an intensive care unit. Journal of the American Medical Association, 282(18), 1745-1751.
Clancy, M., Graepler, A., Wilson, M., Douglas, I., Johnson, J., & Price, C. S. (2006). Active screening in high-risk units is an effective and cost-avoidant method to reduce the rate of methicillin-resistant Staphylococcus aureus infection in the hospital. Infection Control and Hospital Epidemiology, 27(10), 1009-1017.
Conterno, L. O., Wey, S. B., & Castelo, A. (1998). Risk factors for mortality in Staphylococcus aureus bacteremia. Infection Control and Hospital Epidemiology, 19(1), 32-37.
Cosgrove, S. E., Qi, Y., Kaye, K. S., Harbarth, S., Karchmer, A. W., & Carmeli, Y. (2005). The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infection Control and Hospital Epidemiology, 26(2), 166-174.
Cosgrove, S. E., Sakoulas, G., Perencevich, E. N., Schwaber, M. J., Karchmer, A. W., & Carmeli, Y. (2003). Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clinical Infectious Diseases, 36(1), 53-59.
Eveillard, M., Lancien, E., Barnaud, G., Hidri, N., Gaba, S., Benlolo, J. A., et al. (2005). Impact of screening for MRSA carriers at hospital admission on risk-adjusted indicators according to the imported MRSA colonization pressure. Journal of Hospital Infection, 59(3), 254-258.
Garrouste-Orgeas, M., Timsit, J. F., Kallel, H., Ben Ali, A., Dumay, M. F., Paoli, B., et al. (2001). Colonization with methicillin-resistant Staphylococcus aureus in ICU patients: morbidity, mortality, and glycopeptide use. Infection Control and Hospital Epidemiology, 22(11), 687-692.
Gastmeier, P., Schwab, F., Geffers, C., & Ruden, H. (2004). To isolate or not to isolate? Analysis of data from the German Nosocomial Infection Surveillance System regarding the placement of patients with methicillin-resistant Staphylococcus aureus in private rooms in intensive care units. Infection Control and Hospital Epidemiology, 25(2), 109-113.
Grundmann, H., Hori, S., Winter, B., Tami, A., & Austin, D. J. (2002). Risk factors for the transmission of methicillin-resistant Staphylococcus aureus in an adult intensive care unit: fitting a model to the data. Journal of Infectious Diseases, 185(4), 481-488.
Haddadin, A. S., Fappiano, S. A., & Lipsett, P. A. (2002). Methicillin resistant Staphylococcus aureus (MRSA) in the intensive care unit. Postgraduate Medical Journal, 78(921), 385-392.
Harbarth, S., Masuet-Aumatell, C., Schrenzel, J., Francois, P., Akakpo, C., Renzi, G., et al. (2006). Evaluation of rapid screening and pre-emptive contact isolation for detecting and controlling methicillin-resistant Staphylococcus aureus in critical care: an interventional cohort study. Critical Care, 10(1), R25.
Harbarth, S., Sax, H., Fankhauser-Rodriguez, C., Schrenzel, J., Agostinho, A., & Pittet, D. (2006). Evaluating the probability of previously unknown carriage of MRSA at hospital admission. American Journal of Medicine, 119(3), 275 e215-223.
Hardy, K. J., Hawkey, P. M., Gao, F., & Oppenheim, B. A. (2004). Methicillin resistant Staphylococcus aureus in the critically ill. British Journal of Anaesthesia, 92(1), 121-130.
Ho, P. L. (2003). Carriage of methicillin-resistant Staphylococcus aureus, ceftazidime-resistant Gram-negative bacilli, and vancomycin-resistant enterococci before and after intensive care unit admission. Critical Care Medicine, 31(4), 1175-1182.
Hsu, C. C, Lin, Y. E., Chen, Y. S., Liu, Y. C., & Muder, R. R. (2008). Validation study of artificial neural network models for prediction of methicillin-resistant Staphylococcus aureus Carriage. Infection Control and Hospital Epidemiology, 29(7),
Ibelings, M. M., & Bruining, H. A. (1998). Methicillin-resistant Staphylococcus aureus: acquisition and risk of death in patients in the intensive care unit. European Journal of Surgery, 164(6), 411-418.
Jaimes, F., Farbiarz, J., Alvarez, D., & Martinez, C. (2005). Comparison between logistic regression and neural networks to predict death in patients with suspected sepsis in the emergency room. Critical care, 9(2), R150-156.
Lim, M. S., Marshall, C. L., & Spelman, D. (2006). Carriage of multiple subtypes of methicillin-resistant Staphylococcus aureus by intensive care unit patients. Infection Control and Hospital Epidemiology, 27(10), 1063-1067.
Lu, P. L., Chin, L. C., Peng, C. F., Chiang, Y. H., Chen, T. P., Ma, L., et al. (2005). Risk factors and molecular analysis of community methicillin-resistant Staphylococcus aureus carriage. Journal of Clinical Microbiology, 43(1), 132-139.
Lucet, J. C., Chevret, S., Durand-Zaleski, I., Chastang, C., & Regnier, B. (2003). Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Archives of Internal Medicine, 163(2), 181-188.
Lucet, J. C., Paoletti, X., Lolom, I., Paugam-Burtz, C., Trouillet, J. L., Timsit, J. F., et al. (2005). Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Medicine, 31(8), 1051-1057.
Lucet, J. C., Grenet, K., Armand-Lefevre, L., Harnal, M., Bouvet, E., Regnier, B., et al. (2005). High prevalence of carriage of methicillin-resistant Staphylococcus aureus at hospital admission in elderly patients: implications for infection control strategies. Infection Control and Hospital Epidemiology, 26(2), 121-126.
Merrer, J., Santoli, F., Appere de Vecchi, C., Tran, B., De Jonghe, B., & Outin, H. (2000). "Colonization pressure" and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infection Control and Hospital Epidemiology, 21(11), 718-723.
NNIS. (2000). National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992-April 2000, issued June 2000. American Journal of Infection Control, 28(6), 429-448.
NNIS. (2004). National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. American Journal of Infection Control, 32(8), 470-485.
Oztoprak, N., Cevik, M. A., Akinci, E., Korkmaz, M., Erbay, A., Eren, S. S., et al. (2006). Risk factors for ICU-acquired methicillin-resistant Staphylococcus aureus infections. American Journal of Infection Control, 34(1), 1-5.
Pittet, D., Hugonnet, S., Harbarth, S., Mourouga, P., Sauvan, V., Touveneau, S., & Perneger, T. V. (2000). Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet, 356(9238), 1307-1312.
Pujol, M., Pena, C., Pallares, R., Ariza, J., Ayats, J., Dominguez, M. A., et al. (1996). Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains. American Journal of Medicine, 100(5), 509-516.
Ridenour, G. A., Wong, E. S., Call, M. A., & Climo, M. W. (2006). Duration of colonization with methicillin-resistant Staphylococcus aureus among patients in the intensive care unit: implications for intervention. Infection Control and Hospital Epidemiology, 27(3), 271-278.
Shang, J. S., Lin, Y. S., & Goetz, A. M. (2000). Diagnosis of MRSA with neural networks and logistic regression approach. Health Care Management Science, 3(4), 287-297.
Sista, R. R., Oda, G., & Barr, J. (2004). Methicillin-resistant Staphylococcus aureus infections in ICU patients. Anesthesiology Clinics of North America, 22(3), 405-435.
Souweine, B., Traore, O., Aublet-Cuvelier, B., Bret, L., Sirot, J., Laveran, H., & Deteix, P. (2000). Role of infection control measures in limiting morbidity associated with multi-resistant organisms in critically ill patients. Journal of Hospital Infection, 45(2), 107-116.
Shulman, L. ＆ Ost, D. (2005). Managing infection in the critical care unit: how can infection control make the ICU safe? Critical Care Clinics, 21(1), 111-128.
Taylor, J. G. (Ed). (1996). Neural Network and Their Application, New York: Wiley.
Theaker, C., Ormond-Walshe, S., Azadian, B., & Soni, N. (2001). MRSA in the critically ill. Journal of Hospital Infection, 48(2), 98-102.
Tilton, D. (2005, October 29). Nosocomial Infections–continuing education course for nurses. Retrieved from http://www.nursingceu. com/courses/74/index_nceu.html
Troche, G., Joly, L. M., Guibert, M., & Zazzo, J. F. (2005). Detection and treatment of antibiotic-resistant bacterial carriage in a surgical intensive care unit: a 6-year prospective survey. Infection Control and Hospital Epidemiology, 26(2), 161-165.
Valls, V., Gomez-Herruz, P., Gonzalez-Palacios, R., Cuadros, J. A., Romanyk, J. P., & Ena, J. (1994). Long-term efficacy of a program to control methicillin-resistant Staphylococcus aureus. European Journal of Clinical Microbiology and Infectious Diseases, 13(1), 90-95.
Weber, S. G., Huang, S. S., Oriola, S., Huskins, W. C., Noskin, G. A., Harriman, K., et al. (2007). Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: Position statement from the Joint SHEA and APIC Task Force. American Journal of Infection Control, 35(2), 73-85.
WHO. (2002). Prevention of hospital-acquired infection, a practical guide, 2nd edition. Retrieved October 29, 2005, from http://www.who.int/ csr/resources/ publications/drugresist/en/whocdscsreph200212.pdf