氯己定/磺胺嘧啶银涂层预防导管相关性血流感染效果的Meta分析

Effectiveness of chlorhexidine/silver sulfadiazine catheters in the prevention of catheter-related bloodstream infections:A traditional meta analysis

目的探讨氯己定/磺胺嘧啶银涂层预防导管相关性血流感染(CRBSI)的效果。方法计算机检索Cochrane Library、Embase、Medline、CINAHL、Web of Science等数据库从建库至2019年3月有关CRBSI预防的临床随机对照试验。采用Cochrane偏倚风险评估工具评估纳入的研究,提取有效数据,采用95%置信区间(CI)计算集合风险比率(RR),测量CRBSI千日率及细菌定植率。以CRBSI千日率为首要结局,细菌定植率为次要结局,采用R3.4.1软件进行Meta分析。结果共纳入17项研究,包括4892例患者。氯己定/磺胺嘧啶银涂层导管的细菌定植率明显低于常规标准导管(RR=0.55,95%CI:0.45~0.68,P=0.02),但CRBSI千日率差异无统计学意义(RR=0.70,95%CI:0.45~1.11,P=0.32)。结论与常规标准导管相比,集束化管理指导下使用氯己定/磺胺嘧啶银涂层导管可降低导管相关细菌定植率,但对CRBSI千日率无影响。

Objective To evaluate the effectiveness of chlorhexidine/silver sulfadiazine catheters vs.conventional standard catheters in the prevention of catheter-related bloodstream infections with bundles.Methods We searched the Cochrane Library,Embase,Medline,CINAHL and Web of Science databases from construction to March 2019 for randomized controlled trials to compare the use of chlorhexidine/silver sulfadiazine catheters and conventional standard catheters.Cochrane bias risk assessment tool was used to evaluate the included research,and the effective data was extracted.The set risk ratio(RR)was calculated with 95%confidence interval(CI),and the rate of CRBSI per 1000 catheter-days and bacterial colonization rate were measured.The primary outcome was CRBSI thousand day rate and the secondary outcome was bacterial colonization rate.The meta analysis was performed by R3.4.1 software.Results Seventeen trials included 4892 patients who received chlorhexidine/sulfadiazine silver coated catheters and conventional standard catheters were included.Compared with conventional standard catheters,chlorhexidine/silver sulfadiazine catheters were associated with a lower incidence of catheter colonization(RR=0.55,95%CI:0.45-0.68,P=0.02).In addition,the the difference of the rate of CRBSI per 1000 catheter-days was not significant(RR=0.70,95%CI:0.48-1.02,P=0.32).Conclusion Compared with conventional standard catheters,the use of chlorhexidine/silver sulfadiazine-catheters with bundles can further reduce the incidence of catheter colonization,but does not reduce the rate of CRBSI per 1000 catheter-days.