中国ICU成人病人多重耐药菌感染影响因素的Meta分析

Influencing factors for multi-drug resistant bacteria infection in ICU patients:a Meta-analysis

目的:系统评价中国重症监护室(ICU)成人病人多重耐药菌感染的影响因素。方法:检索中国知网、维普数据库、万方数据库、中国生物医学文献数据库、PubMed、Web of Science、EMbase、the Cochrane Library、EBSCO、Wiley Online Library、CINAHL等建库至2023年8月14日发表的与中国ICU成人病人多重耐药菌感染影响因素相关的病例对照研究和队列研究。由2名研究者筛选文献、资料提取、质量评价。采用RevMan 5.3软件进行Meta分析。结果:共纳入29篇文献,Meta分析结果显示,有基础疾病[OR=2.13,95%CI(1.55,2.92),P<0.0001]、意识障碍[OR=4.27,95%CI(2.70,6.77),P<0.0001]、低蛋白血症[OR=3.00,95%CI(1.90,4.75),P<0.0001]、使用抗菌药[OR=2.55,95%CI(1.68,3.88),P<0.0001]、抗菌药使用时间[OR=2.48,95%CI(1.27,4.85),P=0.008]、使用呼吸机[OR=1.25,95%CI(1.04,1.50),P=0.02]、机械通气[OR=2.88,95%CI(1.62,5.11),P=0.0003]、机械通气时间[OR=3.03,95%CI(1.73,5.31),P<0.0001]、静脉置管[OR=2.16,95%CI(1.45,3.22),P<0.0001]、留置尿管[OR=2.13,95%CI(1.32,3.423),P=0.002]、ICU住院时间[OR=3.79,95%CI(2.51,5.74),P<0.0001]、接受手术[OR=1.73,95%CI(1.38,2.16),P<0.0001]、侵入性操作[OR=4.32,95%CI(2.08,8.97),P<0.0001]是中国ICU成人病人多重耐药菌感染的危险因素,女性[OR=0.68,95%CI(0.54,0.85),P=0.0008]是其保护因素。结论:男性、有基础疾病、意识障碍、低蛋白血症、使用抗菌药、抗菌药使用时间长、使用呼吸机、机械通气、机械通气时间长、静脉置管、留置尿管、ICU住院时间超过7 d、接受手术、有侵入性操作的病人更易发生多重耐药菌感染。

Objective:To systematically evaluate the influencing factors of multidrug-resistant bacteria infection in adult intensive care unit(ICU)patients in China.Methods:Case control studies and cohort studies related to the influencing factors of multidrug-resistant bacterial infections in adult ICU patients in China were retrieved from databases such as CNKI,VIP,WanFang Database,CBM,PubMed,Web of Science,EMbase,the Cochrane Library,EBSCO,Wiley Online Library,CINAHL,etc.The search period was from August 14,2023.2 researchers conducted literature screening,data extraction,and quality evaluation.RevMan 5.3 was used for Meta analysis.Results:A total of 29 articles were included.Meta-analysis results showed that underlying diseases(OR=2.13,95%CI 1.55-2.92,P<0.0001),disturbance of consciousness(OR=4.27,95%CI 2.70-6.77,P<0.0001),hypoproteinemia(OR=3.00,95%CI 1.90-4.75,P<0.0001),use of antimicrobials(OR=2.55,95%CI 1.68-3.88,P<0.0001),duration of use of antimicrobials(OR=2.48,95%CI 1.27-4.85,P=0.008),use of ventilators(OR=1.25,95%CI 1.04-1.50,P=0.02),mechanical ventilation(OR=2.88,95%CI 1.62-5.11,P=0.0003),duration of mechanical ventilation(OR=3.03,95%CI 1.73-5.31,P<0.0001),intravenous catheterization(OR=2.16,95%CI 1.45-3.22,P<0.0001),indurating catheter(OR=2.13,95%CI 1.32-3.423,P=0.002),length of ICU stay(OR=3.79,95%CI 2.51-5.74,P<0.0001),surgery(OR=1.73,95%CI 1.38-2.16,P<0.0001),and invasive procedures(OR=4.32,95%CI 2.08-8.97,P<0.0001)were risk factors for multidrug-resistant bacterial infection in adult ICU patients in China.Women(OR=0.68,95%CI 0.54-0.85,P=0.0008)was its protective factor.Conclusion:Men,patients with underlying diseases,disturbance of consciousness,hypoproteinemia,use of antibiotics,long use of antibiotics,use of ventilators,mechanical ventilation,mechanical ventilation for a long time,intravenous catheterization,indurating catheter,ICU stay for more than 7 days,surgery,and invasive procedures are more likely to develop multidrug-resistant bacterial infections.