我国成人患者抗生素相关性腹泻危险因素的Meta分析

Risk Factors for Antibiotic-associated Diarrhea in Chinese Adult Patients:A Meta-analysis

目的:系统评价我国成人患者抗生素相关性腹泻(AAD)的危险因素,为临床提供循证参考。方法:计算机检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Embase等数据库,收集我国成人患者AAD危险因素的病例对照研究,检索时限为2000年1月-2018年1月。提取资料并按照纽卡斯尔-渥太华质量评估量表对纳入文献进行质量评价后,采用Rev Man 5.2软件进行Meta分析。结果:共纳入14篇文献,共计20 914例患者。Meta分析结果显示,年龄≥65岁[OR=2.36,95%CI(1.99,2.79),P<0.001]、禁食[OR=4.65,95%CI(3.79,5.69),P<0.001]、使用抑酸剂[OR=5.82,95%CI(3.77,8.98),P<0.001]、血清白蛋白水平≤30 g/L[OR=2.40,95%CI(2.00,2.88),P<0.001]、侵袭性操作[OR=3.95,95%CI(3.03,5.15),P<0.001]、入住ICU[OR=2.93,95%CI(2.38,3.60),P<0.001]、住院天数≥10 d[OR=4.08,95%CI(3.31,5.03),P<0.001]、使用抗生素种类≥3种[OR=1.98,95%CI(1.56,2.51),P<0.001]和抗生素用药时间≥10 d[OR=6.16,95%CI(3.22,11.76),P<0.001]与ADD的发生有显著相关性。结论:年龄≥65岁、禁食、使用抑酸剂、血清白蛋白水平≤30 g/L、侵袭性操作、入住ICU、住院天数≥10 d、使用抗生素种类≥3种和抗生素用药时间≥10 d是我国成人患者发生AAD的危险因素。

OBJECTIVE:To evaluate the risk factors for antibiotic-associated diarrhea(AAD)in Chinese adult patients systematically,and to provide evidence-based reference in clinic.METHODS:Retrieved from CNKI,VIP,CBM,Wanfang database,PubMed and Embase,etc.,disease control studies about AAD risk factors of Chinese adult patients were collected.The retrieval time limit ranged from Jan.2000 to Jan.2018.Meta-analysis was performed by using Rev Man 5.2 software after data extraction and quality evaluation of included literatures with NOS scale.RESULTS:A total of 14 literatures were included,involving 20 914 patients.The result of Meta-analysis showed that age≥65 years[OR=2.36,95%CI(1.99,2.79),P<0.001],fasting[OR=4.65,95%CI(3.79,5.69),P<0.001],use of acid suppressant[OR=5.82,95%CI(3.77,8.98),P<0.001],serum albumin≤30 g/L[OR=2.40,95%CI(2.00,2.88),P<0.001],invasive operation[OR=3.95,95%CI(3.03,5.15),P<0.001],stay in ICU[OR=2.93,95%CI(2.38,3.60),P<0.001],hospitalization time≥10 d[OR=4.08,95%CI(3.31,5.03),P<0.001],antibiotic species≥3 kinds[OR=1.98,95%CI(1.56,2.51),P<0.001]and duration of antibiotics use≥10 d[OR=6.16,95%CI(3.22,11.76),P<0.001]were significantly correlated with the occurrence of AAD.CONCLUSIONS:Age≥65 years,fasting,use of acid suppressant,serum albumin≤30 g/L,invasive operation,stay in ICU,time of hospitalization≥10 d,antibiotic species≥3 kinds and duration of antibiotics use≥10 d are risk factors for AAD in Chinese adult patients.