系统评价抗生素在预防新生儿深静脉置管相关感染中的价值

Systematic review of prophylactic antibiotics in the prevention of catheter-related bloodstream infection in newborn infants

目的系统评价抗生素预防新生儿深静脉置管相关感染的价值。方法通过文献检索收集抗生素预防新生儿深静脉置管相关感染的随机对照研究,检索时间1990年1月至2012年4月,应用RevMan5.0分析软件,将资料进行定量综合,对同质资料进行Meta分析,采用两个比值比(OR)及其95%可信区间(95%CI)表示。结果共纳入6项研究,预防应用抗生素组(观察组)共270例,未预防应用抗生素组(对照组)共272例。Meta分析结果表明,观察组与对照组相比,可以减少新生儿深静脉置管导管相关血流感染(OR=0.14,95%CI:0.07～0.29),减少深静脉置管导管细菌定植(OR=0.41,95%CI:0.23～0.71),差异均有统计学意义(P<0.05);两组新生儿深静脉置管时病死率、颅内出血发生率、坏死性小肠结肠炎发生率、抗生素耐药发生率的差异均无统计学意义(P>0.05)。对预防应用抗生素的方法进行亚组分析,结果表明静脉输液、抗生素和肝素混合冲管两种方式对结局指标没有影响。结论预防应用抗生素虽然可以减少导管相关血流感染与导管细菌定植的发生率,但由于对最终结局指标(病死率)影响不大,不应常规使用;抗生素与肝素混合冲管方式纳入研究样本量偏少,对抗生素耐药的监测指标缺失,因而有必要进一步开展高质量、大样本随机对照试验评价其疗效和安全性。

Objective To assess the effect of prophylactic antibiotics in the prevention of catheter-related bloodstream infection （CRBSI） in newborn infants. Methods We searched the randomizedcontroller（RCT） studies on prophylactic antibiotics to prevent catheter-related bloodstream infection （CRBSI）in neonates from 1 January, 1990 to 30 April, 2012 ,and performed meta-analysis with results from homogenous studies using Rev Man 5.0 software to assess the odds ratio （OR） and 95% confidence intervals （95% CI）. Results Six studies were included. A total of 270 cases were in the group of prophylactic antibiotics （ observation group）, and 272 cases were in the group without antibiotics （control group）. Meta-analysis showed that the observation group had decreased incidence of CRBSI （ OR = 0. 14, 95% CI： 0. 07 - 0. 29）, and catheter colonization （ OR = 0.41, 95% CI： 0. 23 - 0. 71 ）.Overall mortality rate, the incidence of intraventricular hemorrhage, necrotizing enterocolitis and antibiotic resistance were similar between the two groups. Subgroup analysis based on the different routes of prophylactic antibiotics showed that there were no statistically significant difference between intravenous antibiotics and antibiotics-heparin lock solution on the outcome. Conclusions Prophylactic intravenous antibiotics in neonates reduced the rate of CRBSI and catheter colonization. However, the overall mortality rate was unaffectd. So, the routine use of prophylactic intravenous antibiotics in neonates with deep venous catheters cannot be recommended. Prophylactic antibiotics-heparin lock solutions in neonates with a deep venous catheter reduced the incidence of CRBSI and catheter colonization. But the small sample size of the included studies and the lack of data on antibiotic resistance mandate further clinical trials with higher quality and larger scale to evaluate its effectiveness and safety.