医院感染嗜麦芽窄食单胞菌危险因素的Meta分析

Meta-analysis on risk factors for healthcare-associated infection with Stenotrophomonas maltophilia

目的系统评价医院感染嗜麦芽窄食单胞菌(SMA)的危险因素。方法检索PubMed、Embase、Cochrane Library、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库以及维普数据库(VIP)中建库至2019年3月发表的有关医院感染SMA危险因素的研究文献,2名研究员独立按照纳入与排除标准筛选文献、提取资料及质量评价后,采用RevMan 5.3软件进行Meta分析。结果共纳入10篇文献,3篇为英文,7篇为中文。Meta分析结果显示,入院时APCHE-II评分>20分(OR=3.69,95%CI:1.58~8.59)、ICU时间>7 d(OR=2.14,95%CI:1.55~2.95)、住院时间(MD=7.54,95%CI:6.22~8.86)、使用糖皮质激素(OR=2.40,95%CI:1.57~3.68)、合并免疫功能缺陷性疾病(OR=2.31,95%CI:1.64~3.25)、机械通气(OR=7.59,95%CI:3.40~11.97)、气管插管(OR=4.98,95%CI:3.21~7.73)、气管切开(OR=4.31,95%CI:2.80~6.64)、中心静脉置管(OR=1.68,95%CI:1.19~2.38)、留置鼻胃管(OR=3.10,95%CI:1.83~5.26)、使用碳青霉烯类(OR=2.81,95%CI:2.24~3.54)、使用β-内酰胺酶抑制剂(OR=3.52,95%CI:1.71~7.24)、使用氨基糖苷类(OR=1.93,95%CI:1.37~2.73)、使用糖肽类(OR=3.42,95%CI:1.13~10.32)和使用抗菌药物≥3种(OR=2.70,95%CI:1.75~4.16)是医院感染SMA的危险因素(均P<0.05)。结论医院感染SMA的危险因素较多,临床应采取针对性预防措施,以降低其感染风险。

Objective To systematically assess risk factors for healthcare-associated infection(HAI)with Stenotrophomonas maltophilia(SMA).Methods Literatures about the risk factors for SMA HAI were retrieved from PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure(CNKI),Chinese Biology Medicine(CBM)database,Wanfang database(Wanfang),and VIP database from the establishment of database to March of 2019,literatures were screened,extracted,and performed quality evaluation according to inclusion and exclusion criteria by two researchers,Meta-analysis was conducted using RevMan 5.3 software.Results A total of 10 literatures were included in study,3 in English and 7 in Chinese.Meta-analysis showed that APCHE-II score>20 at admission(OR=3.69,95%CI:1.58-8.59),length of ICU stay>7 days(OR=2.14,95%CI:1.55-2.95),length of hospital stay(MD=7.54,95%CI:6.22-8.86),use glucocorticoid(OR=2.40,95%CI:1.57-3.68),combined with immunodeficiency disease(OR=2.31,95%CI:1.64-3.25),mechanical ventilation(OR=7.59,95%CI:3.40-11.97),tracheal intubation(OR=4.98,95%CI:3.21-7.73),tracheotomy(OR=4.31,95%CI:2.80-6.64),central venous catheterization(OR=1.68,95%CI:1.19-2.38),indwelling nasogastric tube(OR=3.10,95%CI:1.83-5.26),use carbapenems(OR=2.81,95%CI:2.24-3.54),useβ-lactamase inhibitors(OR=3.52,95%CI:1.71-7.24),use aminoglycosides(OR=1.93,95%CI:1.37-2.73),use glycopeptides(OR=3.42,95%CI:1.13-10.32)and use antimicrobial agents≥3 kinds(OR=2.70,95%CI:1.75-4.16)were risk factors for SMA HAI(all P<0.05).Conclusion There are many risk factors for SMA HAI,targeted preventive measures should be taken in clinical practice to reduce the risk of infection.