耐碳青霉烯肠杆菌流行特征的Meta分析

Meta analysis of the epidemic characteristics of carbonpenem Enterobacteriaceae

目的分析耐碳青霉烯肠杆菌(CRE)的检出率,不同种属及其基因型的分布情况,为了解耐碳青霉烯肠杆菌科细菌的流行情况、控制其传播及碳青酶烯抗生素的合理使用提供依据。方法采用循证医学的方法,检索Pub Med、维普数据库、中国期刊全文数据库、万方数据库、中国生物医学文献数据库的国内外耐碳青霉烯肠杆菌的研究文献,严格按照纳入标准进行文献筛选并进行STROBE评价,提取相关数据用R 3.1.3软件进行统计分析。结果纳入11个文献,异质性检验显示I^2=96.4%,P<0.000 1,提示纳入的文献间存在异质性,CRE检出率为1.00%(95%CI:0.01~0.02)。剔除3篇评分较低的文献,异质性检验显示I^2=95.2%,P<0.000 1,合并检出率为2.00%(95%CI:0.01~0.04)。结论本次研究中纳入的11篇文献,合并检出率结果变化相对稳定,文献质量对结果有影响,肺炎克雷伯菌在CRE流行株中占主要地位,KPC是产碳青烯酶的主要基因类型。

Objective To understand the epidemic situation of resistance of carbonpenem Enterobacteriaceae bacteria（ CRE）,systemically analyze the detection rate of CRE,and the distribution of different species and genotypes. Methods Using method of Evidence-based medicine,by searching Pub Med,VIP,CNKI,Wanfang and Chinese biomedical database（ CBM）,the domestic and overseas study for resistance of CRE were analyzed,the studies were strictly screened,the quality of included studies were evaluated by STROBE,data was extracted and analyzed by software R 3. 1. 3. Results 11 literatures were inclued,it showed that the heterogeneity test： I^2= 96. 4%,and the combined detection rate was 1. 00%（ 95% CI： 0. 01-0. 02）,P〈0. 000 1. After eliminating 3 low scored papers,heterogeneity test showed： I^2= 95. 2%,P〈0. 000 1,the combined detection rate was 2. 00%（ 95% CI： 0. 01-0. 04）. Conclusion Combined rate is relatively stable in the analyse. Klebsiella pneumoniae for CRE isolates accounted for the main position,KPC was the main genetic types.