我国住院患者鲍氏不动杆菌血流感染死亡率的Meta分析

Mortality rates of hospitalized patients with Acinetobacterbaumannii bloodstream infections in China:a meta-analysis

目的运用Meta分析评价我国住院患者鲍氏不动杆菌血流感染(Acinetobacter baumannii bacteremia,ABB)的死亡率,为临床治疗与防控提供参考。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2018年1月31日间发表并报道了ABB预后(死亡)情况的研究文献。应用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软件进行合并分析。结果共纳入34篇文献,总样本量为2 994例,ABB患者整体合并死亡率为42%(95%CI:37%~48%),其中明确为医院获得性ABB的患者死亡率为41%(95%CI:32%~50%);亚组分析显示:ICU患者ABB合并死亡率为52%高于非ICU患者的46%(P<0.001);MDRAB、CRAB、XDRAB导致的血流感染患者合并死亡率分别为50%、40%、69%高于非耐药菌感染的患者(P<0.001)。结论我国住院患者ABB死亡率较高,需要重视ICU患者管理,减少耐药鲍氏不动杆菌的产生和感染。

OBJECTIVE To investigate the mortality rate of hospitalized patients with Acinetobacter baumannii bloodstream infections in China through meta-analysis so as to provide guidance for clinical prevention and treatment.METHODS The literatures in regard to the prognosis（death）of A.baumannii bloodstream infections were retrieved from PubMed,CNKI,CBM,Wanfang database and VIP information resource system from the inception to Jan 31,2018.The quality of the included literatures was evaluated based on the evaluation criteria for quality of research on morbidity and mortality,and the pooled mortality was estimated by using R software.RESULTS Totally 34 literatures were included,with the total sample size 2 994 cases,and the pooled mortality rate of the patients with A.baumannii bloodstream infections was 42%（95%CI：37%-48%）,the mortality rate of the patients who were conformed with hospital-acquired A.baumannii bloodstream infections was 41%（95%CI：32%-50%）.The subgroup analysis indicated that the pooled mortality rate of the ICU patients with A.baumannii bloodstream infections was 52%,higher than 46% of the non-ICU patients（P〈0.001）.The pooled mortality rates of the patients with MDRAB,CRAB,and XDRAB bloodstream infections were respectively 50%,40%,and 69%,significantly higher than those of the patients with non-drug-resistant bacteria infections（P〈0.001）.CONCLUSIONThe mortality rate of the hospitalized patients with A.baumannii bloodstream infections is high in China,and it is necessary to pay high attention to the management of the ICU patients so as to reduce the incidence of the infections caused by the drug-resistant A.baumannii.