鲍氏不动杆菌血流感染患者死亡相关因素的Meta分析

Related factors for mortality of patients with Acinetobacterbaumannii bloodstream infection:a meta-analysis

目的系统评价鲍氏不动杆菌血流感染(ABB)患者死亡的相关因素。方法检索PubMed、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库(Wanfang)以及维普信息资源系统(VIP)中建库至2018年1月发表的相关文献,由2名研究员独立按照纳入与排除标准筛选文献、提取数据及质量评价后,采用RevMan5.3和Stata14.0软件进行Meta分析。结果最终纳入文献39篇。Meta分析显示,感染性休克(OR=5.17,95%CI:3.06~8.73)、MDR-ABB(OR=6.76,95%CI:2.85~16.03)、Pitt菌血症评分(OR=1.74,95%CI:1.21~2.52)、CR-ABB(OR=3.08,95%CI:1.35~7.04)、入住ICU(OR=2.57,95%CI:1.22~5.43)、使用呼吸机(OR=3.94,95%CI:2.80~5.54)、APACHE II评分(OR=1.19,95%CI:1.15~1.23)、中性粒细胞缺乏(OR=5.48,95%CI:2.95~10.20)、免疫抑制(OR=4.60,95%CI:2.17~9.76)、恶性肿瘤(OR=4.12,95%CI:2.81~6.03)、不当的抗菌药物治疗(OR=4.73,95%CI:3.16~7.08)、SOFA评分(OR=1.35,95%CI:1.24~1.46)、ABB来源于呼吸道(OR=3.30,95%CI:2.17~5.03)等为ABB患者死亡的相关因素。结论感染性休克、MDRABB、Pitt菌血症评分、CR-ABB、入住ICU、使用呼吸机、APACHE II评分、中性粒细胞缺乏、免疫抑制、恶性肿瘤、不当的抗菌药物治疗、SOFA评分、血流感染来源于呼吸道等13个因素与ABB患者死亡密切相关。识别可控制的相关因素并进行干预,对降低ABB患者死亡率有积极作用。

OBJECTIVE To systematically review the related factors for death of the patients with Acinetobacter baumannii bloodstream infection.METHODS The databases including PubMed,CNKI,CBM,WanFang and VIP were electronically searched for related literature that were published from the establishment of the databases to Jan 2018,the eligible literatures were screened out by 2 researchers according to the inclusion and exclusion criteria,the data were extracted,the quality was evaluated,and the meta-analysis was performed with the use of RevMan5.3 and Stata14.0 software.RESULTS A total of 39 literatures were included.The meta-analysis showed that the related factors for death of the patients with A.baumannii bloodstream infection included the septic shock（OR=5.17,95%CI：3.06-8.73）,MDR-ABB（OR=6.76,95%CI：2.85-16.03）,Pitt bacteremia score（OR=1.74,95%CI：1.21-2.52）,CR-ABB（OR=3.08,95%CI：1.35-7.04）,ICU stay（OR=2.57,95%CI：1.22-5.43）,use of ventilator（OR=3.94,95%CI：2.80-5.54）,APACHE II score（OR=1.19,95%CI：1.15-1.23）,neutrophil deficiency（OR=5.48,95%CI：2.95-10.20）,immunosuppression（OR=4.60,95%CI：2.17-9.76）,malignant tumor（OR=4.12,95%CI：2.81-6.03）,inappropriate antibiotic therapy（OR=4.73,95%CI：3.16-7.08）,SOFA score（OR=1.35,95%CI：1.24-1.46）and respiratory tract ABB（OR=3.30,95%CI：2.17-5.03）.CONCLUSIONS The mortality of the patients with A.baumannii bloodstream infection is closely associated with the 13 factors such as septic shock,MDR-ABB,Pitt bacteremia score,CR-ABB,ICU stay,use of ventilator,APACHE II score,neutrophil deficiency,immunosuppression,malignant tumor,inappropriate antibiotic therapy,SOFA score and respiratory tract bloodstream infection.It is of positive role to identify the controllable factors and take intervention measures so as to reduce the mortality rate of the patients with A.baumannii bloodstream infection.