创伤继发侵袭性真菌感染特征及高危因素Meta分析

Meta-analysis on the characteristics and risk factors of invasive fungal infection secondary to trauma

目的 Meta分析国内外创伤后继发侵袭性真菌感染(IFI)特征、高危因素及治疗方法,为创伤治疗过程中侵袭性真菌感染的应对提供循证医学证据。方法采取主题词与自由词相结合构建检索式,运用布尔逻辑检索,将不同关键字进行组合查询,检索CBM、CNKI、万方、维普等中文数据库和Pubmed、SCI、OVID及Embase等英文数据库,检索1997年12月—2017年12月发表的文献,选择语言种类限制在中文和英文,按预先设定的纳入和排除标准筛选,综合各文献的统计指标比值比(OR),文献总结后的结果使用相对应的统计学指标进行描述。结果最后纳入8篇中英文病例-随机对照文献,因创伤后继发IFI 772例。总感染部位772例次,其中呼吸道(36%)、泌尿道(26%)、消化道(21%)位居感染前三;念珠菌(52%)、酵母菌(37%)、隐球菌(17%)是造成创伤后侵袭性感染的主要菌种;IFI混合细菌感染主要是金黄色葡萄球菌(42%)、大肠杆菌(27%)、铜绿假单胞菌(16%)。感染后主要临床表现为发热(49%)、中性粒细胞升高(31%)、白细胞增多(35%)等。以手术清创与抗真菌药物(两性霉素-B和氟康唑)治疗为主。结论呼吸道和泌尿道为创伤后继发侵袭性真菌感染的主要单部位;病原菌主要为念珠菌、酵母菌、隐球菌,以手术清创与抗真菌药物(两性霉素-B和氟康唑)治疗为主。

Objective Meta-analysis was performed on the characteristics,high risk factors and treatment methods of invasive fungal infections after trauma at home and abroad so as to provide evidence-based medical evidence for the response of invasive fungal infections in the process of trauma treatment.Methods The combination of subject words and free words was adopted to construct the retrieval mode,and different keywords were combined and queried by using Boolean logic to search Chinese databases such as CBM,CNKI,WanFang and VIP,and English databases such as PubMed,SCI,Ovid and Embase. The literatures published from Dec.1997 to Dec.2017 were retrieved,and the language types were restricted to Chinese and English. Screening was conducted according to the preset inclusion and exclusion criteria. The statistical index OR(Odds Ratio) value of each literature was integrated,and the results of literature summarization were described by the corresponding statistical index.Results Finally,8 Chinese and English case-randomized controlled literatures were selected,including 772 cases of invasive fungal infection secondary to trauma.The total infected sites were 772 cases,among which the respiratory tract(36%),urinary tract(26%) and digestive tract(21%) were the top three infected sites. Saccharomyces albicans(52%),Saccharomyces albicans(37%) and Cryptococcus(17%) were the main strains of invasive post-traumatic infection. The most common invasive fungal and mixed bacterial infections were Staphylococcus aureus(42%),Escherichia coli(27%) and Pseudomonas aeruginosa(16%). The main clinical manifestations of infection were fever(49%),neutrophils(31%) and leukocytosis(35%),etc.Surgical debridement and antifungal drugs(amphotericin-B and fluconazole) were the main treatments.Conclusion Respiratory tract and urinary tract are the main sites of invasive fungal infection after trauma. The main pathogenic bacteria are Saccharomyces albicans,Saccharomyces albicans and Cryptococcus. Surgical debridement and antifungal drugs(amphotericin-B and fluconazole) are the main treatments.