预防使用抗菌药物对导尿管相关性尿路感染影响的meta分析

Meta-analysis of antibiotics prophylaxis for catheter-associated urinary tract infection

目的系统评价预防使用抗菌药物对降低导尿管相关性尿路感染发生的影响。方法检索Pub Med、Cochrane library、Wiley Online Library、CNKI和万方数字化期刊全文数据库,收集2014年3月以前发表的关于预防使用抗菌药物对导尿管相关性尿路感染影响的随机对照试验,按照纳入标准和排除标准对入选文献进行资料提取、方法学质量评价后,用Rev Man 5.2软件进行meta分析,依据研究的异质性与偏倚进行敏感性分析,并采用GRADE系统评价证据质量和推荐等级。结果最终纳入13个研究,meta分析结果显示:抗菌药物组在拔除导尿管48 h内菌尿症、预防用药结束后7 d内菌尿症、单剂量干预结束后菌尿症、预防用药结束后脓尿、预防用药结束后尿培养阳性方面与对照组比较,合并效应量的异质性小且有显著性差异。基于结局指标的GRADE系统的证据推荐等级评价显示:抗菌药物组与对照组比较的12个结局指标中,除留置期间菌尿症、预防用药结束后发热和随访期间脓尿这3个结局指标为低级证据外,其余均为高级证据。抗菌药物组可有效降低拔除导尿管48 h内菌尿症、预防用药结束后7 d的菌尿症、单剂量干预后菌尿症、预防用药结束后脓尿、预防用药结束后尿培养阳性等发生。结论目前有效证据支持术前无尿路感染患者(如糖尿病患者或免疫缺陷患者等)围手术期后短期留置导尿管时,拔除导尿管前或后48 h内预防使用单剂量抗菌药物可有效减少继发尿路感染的发生。该结论还需要更多高质量大样本随机对照试验加以证明。

Objective To review the effectiveness and safety of antibiotics prophylaxis for catheter-associated urinary tract infections（CA-UTI）.Methods Databases including Pub Med, Cochrane library, Wiley Online Library, China Knowledge Resource Integrated Database（CNKI） and WANFANG databases were searched from establishment to March 2014 to collect randomized controlled trials（RCTs） on the effectiveness and safety of antibiotics prophylaxis for CA-UTI. According to the inclusion and exclusion criteria, data of the included studies were collected, and the methodological quality was evaluated. Meta-analysis was performed with Rev Man 5.2. Sensitivity analysis was based on heterogeneity and bias of the studies, and the evidence qualities and recommendation levels were determined by the GRADE system. Results A total of 13 studies were included. The meta-analysis showed small amount of heterogeneity in combined effect and significant differences in bacteriuria with removal of the catheter within 48 h, bacteriuria after antibiotic prophylaxis ending within 7 d, bacteriuria after single-dose intervention, pyuria after antibiotic prophylaxis ending and positive urine culture after antibiotic prophylaxis ending in the antibiotic group and the control group. Based on GRADE system, 12 outcome indexex between the antibiotic group and the control group were strong evidences, excluding 3 weak evidences such as bacteriuria with indwelling catheter, fever after antibiotic prophylaxis ending and pyuria during follow-up. The antibiotic group effectively reduced the bacteriuria with the removal of catheter within 48 h, bacteriuria after antibiotic prophylaxis ending within 7 d, bacteriuria after a single dose of intervention, pyuria after antibiotic prophylaxis ending and positive urine culture after antibiotic prophylaxis ending. Conclusion Surgery patients（such as diabetics or immunocompromised patients） without urinary tract infection before surgery and with short-time indwelling catheters after the perioperative stage may use single-dose antibiotics before or after the removal of indwelling catheters within 48 h, which can effectively reduce secondary urinary tract infection. This conclusion needs further proof with more high-quality and large-scale RCTs.