新生儿多重耐药菌感染危险因素的meta分析

Risk Factors for Multi-drug Resistant Bacterial Infection in Neonates:A Meta-Analysis

目的通过meta分析明确新生儿多重耐药菌(MDRO)感染的危险因素。方法计算机检索PubMed、the Cochrane Library、Web of Science、Embase、CNKI、CBM、VIP和WanFang数据库,搜集有关新生儿MDRO感染危险因素的病例对照研究和队列研究,检索时限均为建库至2021年1月。由2名研究者独立筛选文献,提取资料并评价纳入研究的偏倚风险,采用RevMan 5.4软件进行meta分析。结果共纳入20个研究,19个病例对照研究和1个队列研究,包括3351例患儿。Meta分析结果显示:住院时间>14 d[OR=2.25,95%CI(1.63~3.11),P<0.001]、联合使用抗菌药物[OR=4.87,95%CI(3.64~6.51),P<0.001]、机械通气[OR=3.00,95%CI(1.94~4.65),P<0.001]、应用碳青霉烯类抗生素[OR=5.44,95%CI(2.50~11.80),P<0.001]、体质量<2500 g[OR=2.11,95%CI(1.14~3.88),P=0.020]、应用抗菌药物时间>7 d[OR=2.47,95%CI(1.85~3.31),P<0.001]、肠外营养[OR=8.34,95%CI(2.41~28.86),P=0.008]、头孢菌素使用史[OR=4.61,95%CI(1.74~12.16),P=0.002]、脐动脉置管[OR=2.93,95%CI(1.36~6.30),P=0.006]是新生儿MDRO感染的危险因素。结论住院时间>14 d、联合使用抗菌药物、机械通气、应用碳青霉烯类抗生素、体质量<2500 g、应用抗菌药物时间>7 d、肠外营养、头孢菌素使用史、脐动脉置管可能是新生儿MDRO感染的危险因素。受纳入研究数量与质量的限制,上述结论尚需更多高质量研究进行验证。

Objective To identify the risk factors for multi-drug resistance bacteria(MDRO)infection in neonates by meta-analysis.Methods PubMed,the Cochrane Library,Web of Science,Embase,CNKI,CBM,VIP and WanFang databases were searched to retrieve case-control studies and cohort studies on risk factors of MDRO infection in neonates.The retrieval time limit was from the establishment of the database to January 2021.Two researchers independently screened the literature,extracted the data,and evaluated the risk of bias in the included studies.Meta-analysis was performed using RevMan 5.4 software.Results A total of 20 studies,19 case-control studies and 1 cohort study,were included,including 3351 children.Meta-analysis results showed that duration of hospital stay greater than 14 days[OR=2.25,95%CI(1.63~3.11),P<0.001],combined use of antibiotics[OR=4.87,95%CI(3.64-6.51),P<0.001],mechanical ventilation[OR=3.00,95%CI(1.94-4.65),P<0.001],carbapenem antibiotics[OR=5.44,95%CI(2.50-11.80),P<0.001],body weight<2500 g[OR=2.11,95%CI(1.14-3.88),P=0.020],antibiotics for more than 7 days[OR=2.47,95%CI(1.85-3.31),P<0.001],parenteral nutrition[OR=8.34,95%CI(2.41-28.86),P=0.008],cephalosporin use history[OR=4.61,95%CI(1.74-12.16),P=0.002]and umbilical artery catheterization[OR=2.93,95%CI(1.36-6.30),P=0.006]were risk factors for neonatal MDRO infection.Conclusion Current evidence suggests that length of hospital stay greater than 14 days,combined use of antibiotics,mechanical ventilation,carbapenems,body weight<2500 g,duration of use of antibiotics greater than 7 days,parenteral nutrition,history of cephalosporin use and umbilical artery catheterization may be risk factors for MDRO infection in neonates.Due to the limitation of the number and quality of included studies,the above conclusions need to be verified by more high-quality studies.