医院感染多重耐药鲍曼不动杆菌患者死亡危险因素的Meta分析

Meta-analysis on risk factors for death in patients with healthcare-asso-ciated infection caused by multidrug-resistant Acinetobacter baumannii

目的系统评价医院感染多重耐药鲍曼不动杆菌(MDR-AB)患者死亡危险因素的相关研究,为制定防控策略提供依据。方法计算机检索数据库关于医院感染MDR-AB患者死亡危险因素的病例对照研究,病例组为因医院感染MDR-AB而死亡的患者(死亡组),对照组为医院感染MDR-AB但未死亡的患者(存活组),根据纳入与排除标准各自筛选文献、提取数据和质量评价后,用Rev Man5. 3软件进行Meta分析。结果最终纳入11个研究,共1 204例医院感染MDR-AB患者,其中死亡组474例,存活组730例。Meta分析结果显示:年龄(MD=3. 99)、低蛋白血症(OR=2. 1)、机械通气(OR=4. 23)、气管插管/切开(OR=2. 5)、深静脉置管(OR=2. 21)、移植术后(OR=3. 12)、入院APACHE II评分高(MD=2. 33)是MDR-AB患者死亡的危险因素(均P <0. 05)。结论医院感染MDR-AB患者死亡的危险因素纷繁复杂,需采取针对性的预防措施。

Objective To systematically evaluate the risk factors for death in patients with healthcare -associated infection(HAI) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB),and provide evidence for formulating prevention and control strategies.Methods Case -control studies on risk factors for death in patients with MDR-AB HAI were searched in computer database,patients died of MDR-AB HAI was in death group,those with MDR-AB HAI but survived was in survival group,Meta-analysis was carried out with RevMan 5.3 software after selecting literature,extracting data,and evaluating quality according to inclusion and exclusion criteria.Results A total of 1 204 patients with MDR-AB HAI in 11 studies were enrolled,474 cases were in death group and 730 cases in survival group.Meta-analysis showed that old age ( MD =3.99),hypoproteinemia ( OR =2.1),mechanical ventilation ( OR =4.23),tracheal intubation/tracheotomy ( OR =2.5),deep venous catheterization ( OR =2.21),post-transplantation ( OR =3.12),and high APACHE II score on admission ( MD =2.33) were risk factors for death in MDR-AB patients (all P <0.05).Conclusion Risk factors for death in patients with MDR-AB HAI are complex,corresponding preventive measures should be taken.