| 王瑞峰,曹大伟,张新日.我国耐碳青霉烯类鲍曼不动杆菌医院感染危险因素的 Meta分析[J].安徽医药,2020,24(11):2121-2127. |
| 我国耐碳青霉烯类鲍曼不动杆菌医院感染危险因素的 Meta分析 |
| A meta?analysis of risk factors for nosocomial infection of carbapenems resistant acinetobacter baumannii in China |
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| DOI：10.3969/j.issn.1009?6469.2020.11.001 |
| 中文关键词: 鲍曼不动杆菌 耐碳青霉烯类 医院感染 危险因素 Meta分析 |
| 英文关键词: Acinetobacter baumannii Carbapenems resistant Nosocomial infection Risk factors Meta?analysis |
| 基金项目:陕西省重点研发计划项目(201803D31093) |
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| 中文摘要: |
| 目的对我国耐碳青霉烯类鲍曼不动杆菌(Carbapenems Resistant Acinetobacter Baumannii，CRAB)医院感染的危险因素进行综合评价，为临床预防和控制感染提供依据。方法计算机检索 PubMed、Embase、Cochrane、Web of Science、中国知网(CNKI)、万方、维普、中国生物医学文献数据库(CBM)共 8个数据库，收集关于我国 CRAB医院感染的危险因素的相关文献。由 2名研究者按照纳入和排除标准筛选文献并提取资料，参考 Newcastle?OttawaScale(NOS)标准进行质量评价，使用 RevMan5.3和 Stata14.0软件进行 Meta分析。结果共纳入 26篇文献，累计 3 752例，其中 CRAB医院感染 1941例，碳青霉烯类敏感鲍曼不动杆菌(Carbapenems Sensitive Acinetobacter Baumannii，CSAB)医院感染 1 811例，对 32个影响因素进行分析，其中 22个因素差异具有统计学意义，分别是年龄(MD＝1.16，95%CI:0.39～1.93)、入院时 APACHE Ⅱ评分(MD＝3.12，95%CI:2.58～3.66)、慢性肺部疾病(OR＝1.44，95%CI:1.02～2.03)、慢性肾功能不全(OR＝1.51，95%CI:1.09～2.10)、低蛋白血症(OR＝1.92， 95%CI:1.20～3.08)、其他细菌感染(OR＝2.03，95%CI:1.57～2.61)、机械通气(OR＝3.95，95%CI:2.56～6.11)、机械通气时间(MD＝3.00，95%CI:0.95～5.04)、气管插管 /切开(OR＝3.10，95%CI:2.07～4.64)、留置尿管(OR＝2.17，95%CI:1.53～3.08)、中心静脉置管(OR＝2.56，95%CI:1.48～4.46)、留置胃管(OR＝2.43，95%CI:1.62～3.63)、抗生素联合应用(OR＝3.05，95%CI:1.60～5.83)、前期使用碳青酶烯类(OR＝5.01，95%CI:3.61～6.96)、前期使用青霉素类(OR＝2.22，95%CI:1.50～3.28)、前期使用 β内酰胺酶抑制剂复合制剂(OR＝2.05，95%CI:1.20～3.51)、前期使用喹诺酮类(OR＝1.26，95%CI:1.06～1.50)、全肠外营养(OR＝1.59，95%CI:1.12～2.24)、糖皮质激素(OR＝1.66，95%CI:1.31～2.11)、入住 ICU(OR＝3.73，95%CI:2.17～6.42)、鲍曼不动杆菌(Acinetobacter Baumannii，AB)感染前住院时间(MD＝1.24，95%CI:0.18～2.30)和总住院时间(MD＝2.88，95%CI:0.27～5.49)。结论应对 CRAB医院感染的危险因素采取针对性措施，预防和控制 CRAB医院感染的发生。 |
| 英文摘要: |
| Objective To comprehensively evaluate the risk factors of nosocomial infection of carbapenems resistant acinetobacter baumannii(CRAB)in China，so as to provide reference for clinical prevention and control of infection.Methods A total of 8 data? bases including PubMed，Embase，Cochrane，Web of Science，CNKI，Wanfang，Weipu and CBM were searched by computer to col?lect relevant literatures on risk factors of CRAB nosocomial infection in China.Literature was selected by 2 researchers according toinclusion and exclusion criteria and data were extracted.Quality evaluation was conducted according to the newton?ottawascale(NOS)standard.Meta?analysis was performed using RevMan5.3 and Stata14.0 software.Results A total of 26 literatures were in? cluded in this study，with a total of 3752 cases，including 1941 cases of CRAB nosocomial infection and 1811 cases of carbapen? ems sensitive acinetobacter baumann(CSAB)nosocomial infection.Thirty?two influencing factors were analyzed，among which 22 were statistically significant，including age(MD＝1.16，9 5% CI:0.39～1.93)and APACHE Ⅱ score at admission(MD＝3.12， 95% CI:2.58～3.66)，chronic pulmonary diseases(OR＝1.44，95% CI:1.02～2.03)，chronic renal insufficiency(OR＝1.51，95% CI:1.09～2.10)，hypoproteinemia(OR＝1.92，95% CI:1.20～3.08)，other bacterial infections(OR＝2.03，95% CI:1.57～2.61)， mechanical ventilation(OR＝3.95，95% CI:2.56～6.11)，the duration of mechanical ventilation(MD＝3.00，95% CI:0.95～5.04)， endotracheal intubation/incision(OR＝3.10，95% CI:2.07～4.64)，indwelling urinary catheter(OR＝2.17，95% CI:1.53～3.08)，central venous catheterization(OR＝2.56，95% CI:1.48～4.46)，indwelling gastric catheter(OR＝2.43，95% CI:1.62～3.63)，com? bined application of antibiotics(OR＝3.05，95% CI:1.60～5.83)，prior use of carbapenases(OR＝5.01，95% CI:3.61～6.96)，pri? or use of penicillins(OR＝2.22，95% CI:1.50～3.28)，prior use of compound preparation of beta?lactamase inhibitors(OR＝2.05， 95% CI:1.20～3.51)，prior use of quinolones(OR＝1.26，95% CI:1.06～1.50)，total enteral nutrition(OR＝1.59，95% CI:1.12～2.24)， glucocorticoids(OR＝1.66，95% CI:1.31～2.11)，admission to ICU(OR＝3.73，95% CI:2.17～6.42)，length of hospital stay before acinetobacter baumannii infection(MD＝1.24，95% CI:0.18～2.30)，and total length of hospital stay(MD＝2.88，95% CI:0.27～5.49).Conclusion Targeted measures should be taken to deal with the risk factors of CRAB nosocomial infection，re?duce and prevent the occurrence of CRAB nosocomial infection. |
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