我国耐碳青霉烯类鲍曼不动杆菌医院感染危险因素的Meta分析

A meta-analysis of risk factors for nosocomial infection of carbapenems resistant acinetobacter baumannii in China

目的对我国耐碳青霉烯类鲍曼不动杆菌(Carbapenems Resistant Acinetobacter Baumannii,CRAB)医院感染的危险因素进行综合评价,为临床预防和控制感染提供依据。方法计算机检索PubMed、Embase、Cochrane、Web of Science、中国知网(CNKI)、万方、维普、中国生物医学文献数据库(CBM)共8个数据库,收集关于我国CRAB医院感染的危险因素的相关文献。由2名研究者按照纳入和排除标准筛选文献并提取资料,参考Newcastle-OttawaScale(NOS)标准进行质量评价,使用RevMan5.3和Stata14.0软件进行Meta分析。结果共纳入26篇文献,累计3752例,其中CRAB医院感染1941例,碳青霉烯类敏感鲍曼不动杆菌(Carbapenems Sensitive Acinetobacter Baumannii,CSAB)医院感染1811例,对32个影响因素进行分析,其中22个因素差异具有统计学意义,分别是年龄(MD=1.16,95%CI:0.39~1.93)、入院时APACHEⅡ评分(MD=3.12,95%CI:2.58~3.66)、慢性肺部疾病(OR=1.44,95%CI:1.02~2.03)、慢性肾功能不全(OR=1.51,95%CI:1.09~2.10)、低蛋白血症(OR=1.92,95%CI:1.20~3.08)、其他细菌感染(OR=2.03,95%CI:1.57~2.61)、机械通气(OR=3.95,95%CI:2.56~6.11)、机械通气时间(MD=3.00,95%CI:0.95~5.04)、气管插管/切开(OR=3.10,95%CI:2.07~4.64)、留置尿管(OR=2.17,95%CI:1.53~3.08)、中心静脉置管(OR=2.56,95%CI:1.48~4.46)、留置胃管(OR=2.43,95%CI:1.62~3.63)、抗生素联合应用(OR=3.05,95%CI:1.60~5.83)、前期使用碳青酶烯类(OR=5.01,95%CI:3.61~6.96)、前期使用青霉素类(OR=2.22,95%CI:1.50~3.28)、前期使用β内酰胺酶抑制剂复合制剂(OR=2.05,95%CI:1.20~3.51)、前期使用喹诺酮类(OR=1.26,95%CI:1.06~1.50)、全肠外营养(OR=1.59,95%CI:1.12~2.24)、糖皮质激素(OR=1.66,95%CI:1.31~2.11)、入住ICU(OR=3.73,95%CI:2.17~6.42)、鲍曼不动杆菌(Acinetobacter Baumannii,AB)感染前住院时间(MD=1.24,95%CI:0.18~2.30)和总住院时间(MD=2.88,95%CI:0.27~5.49)。结论应对CRAB医院感染的危险因素采取针对性措施,预防和控制CRAB医院感染的发生。

Objective To comprehensively evaluate the risk factors of nosocomial infection of carbapenems resistant acinetobacter baumannii(CRAB)in China,so as to provide reference for clinical prevention and control of infection.Methods A total of 8 databases including PubMed,Embase,Cochrane,Web of Science,CNKI,Wanfang,Weipu and CBM were searched by computer to collect relevant literatures on risk factors of CRAB nosocomial infection in China.Literature was selected by 2 researchers according to inclusion and exclusion criteria and data were extracted.Quality evaluation was conducted according to the newton-ottawascale(NOS)standard.Meta-analysis was performed using RevMan5.3 and Stata14.0 software.Results A total of 26 literatures were included in this study,with a total of 3752 cases,including 1941 cases of CRAB nosocomial infection and 1811 cases of carbapenems sensitive acinetobacter baumann(CSAB)nosocomial infection.Thirty-two influencing factors were analyzed,among which 22 were statistically significant,including age(MD=1.16,95%CI:0.39~1.93)and APACHEⅡscore at admission(MD=3.12,95%CI:2.58~3.66),chronic pulmonary diseases(OR=1.44,95%CI:1.02~2.03),chronic renal insufficiency(OR=1.51,95%CI:1.09~2.10),hypoproteinemia(OR=1.92,95%CI:1.20~3.08),other bacterial infections(OR=2.03,95%CI:1.57~2.61),mechanical ventilation(OR=3.95,95%CI:2.56~6.11),the duration of mechanical ventilation(MD=3.00,95%CI:0.95~5.04),endotracheal intubation/incision(OR=3.10,95%CI:2.07~4.64),indwelling urinary catheter(OR=2.17,95%CI:1.53~3.08),central venous catheterization(OR=2.56,95%CI:1.48~4.46),indwelling gastric catheter(OR=2.43,95%CI:1.62~3.63),combined application of antibiotics(OR=3.05,95%CI:1.60~5.83),prior use of carbapenases(OR=5.01,95%CI:3.61~6.96),prior use of penicillins(OR=2.22,95%CI:1.50~3.28),prior use of compound preparation of beta-lactamase inhibitors(OR=2.05,95%CI:1.20~3.51),prior use of quinolones(OR=1.26,95%CI:1.06~1.50),total enteral nutrition(OR=1.59,95%CI:1.12~2.24),glucocorticoids(OR=1.66,95%CI:1.31~2.11),admission to ICU(OR=3.73,95%CI:2.17~6.42),length of hospital stay before acinetobacter baumannii infection(MD=1.24,95%CI:0.18~2.30),and total length of hospital stay(MD=2.88,95%CI:0.27~5.49).Conclusion Targeted measures should be taken to deal with the risk factors of CRAB nosocomial infection,reduce and prevent the occurrence of CRAB nosocomial infection.