ICU前床位居住者获得多重耐药菌风险的Meta分析

Risk of multidrug-resistant organism acquisition from prior bed occupants in the ICU:a systematic review and meta-analysis

目的系统评价重症监护病房(intensive care unit,ICU)前床位居住者获得多重耐药菌(multidrug-resistant organism,MDRO)的风险,为ICU MDRO的预防与管理提供指导。方法检索PubMed (n=240)、Embase (n=785)、Cochrane (n=380)数据库获得文献1 405篇。筛选文献,排除计划书、综述、编辑信及文题和摘要不符的文献,去重后剩余文献49篇。进行全文阅读,又排除41篇,剩余8篇,排除同一作者数据1篇,最终纳入7篇文献,共包括82 640例患者。采用RevMan 5.3软件行Meta分析。结果 7篇共计11项结果采用随机效应模型进行分析,暴露因素为前床位居住者感染或定植过MDRO的患者为10 751例,其中感染或定殖MDRO的发生数为508例(4.73%),对照组为无暴露因素患者71 889例,其中感染或定植MDRO的发生数为2 197例(3.06%),合并OR值1.6 (95%CI=1.31, 1.94),结果差异具有统计学意义(P<0.05)。6项结果采用固定效应模型分析,发现暴露因素为前床位居住者感染或定植过多重耐药革兰氏阳性球菌,OR值1.53,95%CI(1.35, 1.73),结果差异具有统计学意义(P<0.05)。4项结果采用随机效应模型进行分析,暴露因素为前床位居住者感染或定植过多重耐药革兰氏阴性杆菌的分析,OR值2.01, 95%CI(1.16, 3.48),结果差异具有统计学意义(P<0.05)。结论 ICU前床位居住者感染或定植过MDRO,会显著增加后一床病患获得MDRO危险性。可以作为ICU医护人员给新患者选择床位时的参考建议。

Objective To systematically evaluate the risk of multidrug-resistant organism(MDRO) acquisition from prior bed occupants in the intensive care unit(ICU), so as to provide guidance for the prevention and management of MDRO.Methods 1 405 papers were retrieved through the access of PubMed(n=240), Embase(n=785) and Cochrane(n=380) databases. Then, a literature screening was made, with all the program plans, reviews, edit letters, titles and abstracts inconsistent with our study excluded from the retrieved literature, and finally 49 papers were obtained. After full-text reading, another 41 papers were excluded, and with the exclusion of still another paper with the data from the same author, only 7 papers were included in the study, involving a total of 82 640 patients. Meta analysis was performed by RevMan 5.3 software.Results Eleven study results obtained from 7 papers were analyzed by using the random effects model. Exposure to prior bed occupants with infected/colonized MDRO resulted in 10 751 cases,of which 508 were such cases(4.73%), while in the control group, there were 71 889 cases without any known exposure factors, of which the rate of infection or colonization of MDRO was 2 197 cases(3.06%), with an OR of 1.6, 95%CI(1.31,1.94), and the results were statistically significant(P<0.05). The 6 results were analyzed using the fixed effect model, revealing that the main factor was exposure to prior bed occupants with infection or colonization of gram positive bacteria, with an OR value of 1.53, 95%CI(1.35,1.73), with statistical significance(P<0.05). The 4 results were analyzed using the random effect model, revealing that the main factor was exposure to prior bed occupants with infection or colonization of multidrug-resistant gram positive bacteria, with an OR value of 2.01(95%CI=1.16,3.48), also with statistical significance(P<0.05).Conclusion Exposure to prior bed occupants with infected/colonized MDRO could significantly increase the risk of MDRO acquisition. Our study results would provide new evidence for ICU medical personnel in the selection of beds for coming new patients.