ICU耐碳青霉烯类肺炎克雷伯菌感染危险因素的Meta分析

Risk factors for carbapenem-resistant Klebsiella pneumoniae infection in ICU:a meta-analysis

目的系统评估我国医院重症监护室(ICU)内发生耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的危险因素。方法计算机检索PubMed、知网、万方等中英文数据库,搜集中国医院ICU内耐碳青霉烯类肺炎克雷伯菌感染危险因素病例对照研究的文献,检索时限从2010年1月1日-2021年8月1日。完成文献筛选后应用RevMan 5.3软件及stata16软件进行Meta分析。结果排除不符合标准文献及重复文献,最终纳入18篇文献,其中中文文献17篇,英文文献1篇,病例组1100例,对照组2570例。Meta分析结果显示,共有23个独立危险因素,其中疾病类有7个,临床处置类有6个,抗生素使用类有10个,疾病类危险因素中心血管疾病,临床处置中留置中心静脉管,抗生素使用中抗菌药物应用时间≥7 d OR值分别为2.07(95%CI1.23~2.39)、1.57(95%CI1.08~2.27)、3.92(95%CI2.86~5.37)。结论基础疾病类、其他细菌感染、抗菌药物的应用、住院时间、有创通气等均为耐碳青霉烯类肺炎克雷伯菌感染的危险因素。临床应根据患者的感染相关因素采用针对性防治措施,结合患者过往病史和用药史,合理应用抗菌药物,规范医护人员操作技术,以减少感染的发生。

OBJECTIVE To systematically evaluate the risk factors for carbapenem-resistant Klebsiella pneumoniae(CRKP)infection of ICU in Chinese hospitals.METHODS PubMed,CNKI,WANFANG and other Chinese and English databases were searched to collect literatures of case-control studies on risk factors for CRKP infection in ICU of Chinese hospitals.The retrieval period is from Jan 1,2010 to Aug 1,2021.Meta-analysis was performed by RevMan 5.3 software and Stata16 software after literature screening.RESULTS Total of 18 articles were selected,including 17 Chinese articles and 1 English article,which included 1100 cases in the case group and 2570 cases in the control group.Meta-analysis showed that 23 independent risk factors were found,including 7 disease,6 clinical treatment and 10 antibiotic use.The OR values of disease risk factors as central vascular disease,clinical treatment as indwelling of central venous tube and antibiotic application time≥7 days were 2.07(95%CI1.23-2.39),1.57(95%CI1.08-2.27),3.92(95%CI2.86-5.37),respectively.CONCLUSION Underlying diseases,other bacterial infections,use of antibiotics,length of hospital stay and invasive ventilation were risk factors for CRKP infection.In clinical practice,targeted prevention and treatment measures should be adopted according to the infection-related factors of patients,combined with the patient’s past medical history and medication history,rational application of antibiotics,and standard operation techniques of medical staff,so as to reduce the occurrence of infection.