经验性抗真菌治疗对降低ICU患者念珠菌感染的meta分析

Meta-analysis of experiential antifungal therapy for reducing Candida infection in ICU patients

目的系统评价预防性使用抗真菌药物能否降低重症监护病房患者的死亡率及感染率。方法用系统评价方法，通过检索数据库Pubmed、Embase、CochraneLibrary、中国生物医学文献数据库、中国知网、中国维普等截止至2016年12月所有关于经验性预防侵袭性念珠菌感染的随机对照研究，同时追查相关参考文献，并逐个进行质量评价和资料提取，采用ReviewManager5.3软件进行meta分析。结果共纳人8个临床研究，共1333例患者。Meta分析结果提示：经验性抗真菌治疗虽然可以阵低ICU患者念珠菌感染的发生率（OR=0.49，95%CI：0.32～0.75，P〈0.05），但并不能提髙患者的生存率（OR=0.93,95%CI：0.32～0.75，P〉0.05），而药物的不良反应率及住院天数差异均无统计学意义（P〉0.05）。结论经验性抗真菌治疗能有效地降低ICU患者念珠菌感染的发生率，但并不能缩短患者住院时间、改善远期生存率。

Objective A systematic review was conducted to determine whether experiential antifungal therapy would decrease the overall mortality rate, the rate of Candidemia or invasive candidiasis in ICU patients. Methods A randomized controlled study was conducted on the systematic review of the database by Pubmed, Embase, Cochrane Library, Chinese Biomedical Literature Database, China Knowledge Network, China, etc, as of December 2016, on the empirical prevention of invasive candidiasis. Tracing the relevant references, and quality evaluation and data extraction, using Review Manager 5.3 software for meta-analysis. Results A total of 1 333 patients were enrolled in 8 clinical studies. Metaanalysis results suggested that empirical antifungal therapy could reduce the incidence of Candida infection in ICU patients （ OR =0.49,95% CI ：0. 32-0. 75, P 〈0. 05） but it did not increase the survival rate of patients （ OR =0. 93, 95% CI ： 0. 32-0.75, P〉0.05）, and there was no significant difference between the adverse reaction rate and the number of hospital days （ P〉0. 05）. Conclusions Although experiential antifungal therapy can effectively reduce the incidence of Candida infection in ICU patients, it has no significant effect on the average length of hospital stay and survival.