我国住院腹泻患者艰难梭菌感染率的荟萃分析

Prevalence rate of Clostridium difficile infection in hospitalized patients with diarrhea in China:a meta-analysis

目的运用荟萃分析评价我国住院腹泻患者艰难梭菌的感染情况,为艰难梭菌的医院感染控制提供依据。方法系统检索PubMed、中国期刊全文数据库(CNKI)、中国生物医学文献数据库、万方数据库以及维普信息资源系统中建库至2016年9月发表的有关我国住院腹泻患者艰难梭菌感染情况的研究文献,参考疾病患病率或发病率研究质量评价准则评价文献质量,采用R软件进行分析,根据患者科室、地区和性别执行亚组分析,通过异质性检验以选择固定效应模型或随机效应模型对感染率进行合并,并用敏感性分析及漏斗图评价发表偏倚。结果共纳入31篇文献,总样本量为9 600人,艰难梭菌整体合并感染率为19%(95%CI:16~22),抗菌药物相关腹泻患者的艰难梭菌感染率为19%(95%CI:13~24);亚组分析显示:不同科室类别、地区、性别的患者,其艰难梭菌感染率存在差异且有统计学意义。结论我国住院腹泻患者艰难梭菌感染率较高,医院需加强对重点人群艰难梭菌感染的防控与管理。

OBJECTIVE To investigate the prevalence rate of Clostridium difficile infection in hospitalized patients with diarrhea in China by means of recta-analysis so as to provide guidance for control of nosocomial infection caused by C. difficile. METHODS The databases such as PubMed, China National Knowledge Internet （CNKI）, Chinese Biomedical Literature Database, Wanfang database, and VIP information were retrieved for the literatures in relating to the prevalence of C. difflcile infection in hospitalized patients with diarrhea that were published in China from the establishment of the databases to September 2016, then the quality of the literature was evaluated by referring to research quality evaluation criteria for prevalence rate or morbidity rate of diseases and was analyzed by using R software, the subgroup analysis was carried out according to the departments, regions, and genders of the patients, the fixed effect model or random effect model was chosen based on the heterogeneity test so as to pool the incidence rate of the infection, and the sensitivity analysis and funnel plot were employed to evaluate the publi- cation bias. RESULTS A total of 31 articles were included in the study, with a total sample size 9 600 patients; the pooled incidence rate of C. difficile infection was 19 % （95 % CI：16 - 22） ; the incidence rate of C. difficile infection was 19% in the patients with antibiotic-related diarrhea （95 % CI： 13 - 24）. The subgroup analysis indicated that there was significant difference in the incidence rate of C. difficile infection among the patients in different departments, regions, or genders. CONCLUSION The prevalence rate of C. difficile infection is relatively high in the hospitalized patients with diarrhea in China. It is necessary for the hospital to strengthen the prevention and management of the key populations with C. difficile infection.