棉拭子取样对比组织取样确定糖尿病足感染病原菌的Meta分析

Wound swab versus tissue sampling in the identification of pathogenic microorganism in diabetic foot infection:a Meta-analysis

目的:采用Meta分析的方法,对比棉拭子取样方法与组织取样方法判断糖尿病足(DF)是否感染病原菌及确定病原菌种类的一致性。方法:检索PubMed、EMbase、Cochrane Library、中国生物医学文献数据库、中国知网、维普和万方数据自建库至2021年3月25日发表的相关文献,由2名独立的研究者对纳入的文献进行评价,并提取数据进行分析。使用RevMan5.3及STATA13软件计算棉拭子取材方法判断DF是否感染病原菌及确定病原微生物的敏感度及特异度,并根据感染的深度进行亚组分析。采用t检验分析病原菌数量、χ^(2)检验分析革兰染色分类的差异。结果:共纳入了6篇研究的725个样本。在评价棉拭子取样方法判断是否感染病原菌时,敏感度合并=0.94(95%CI为0.82~0.98),特异度合并=0.59(95%CI为0.33~0.81);棉拭子取样方法确定病原微生物的敏感度合并=0.71(95%CI为0.46~0.87),特异度合并=0.28(95%CI为0.14~0.49),集成受试者工作特征曲线拟合曲线下面积0.45(95%CI为0.41~0.60)。在亚组分析中,浅部感染组的敏感度较深部感染组高(P<0.01),两种取样方法在得到的病原菌数量、革兰染色分类上差异无统计学意义(P>0.05)。讨论棉拭子取样对判断是否感染病原菌具有较高的价值,但其准确识别DFI病原微生物的效果较差,棉拭子取样方法并不能完全取代组织取样方法。

Objective To compare swab sampling method with tissue sampling method to determine whether diabetic foot(DF)were infected pathogenic bacteria and to determine the consistency of pathogenic microorganism by using Meta-analysis method.Methods Relevant literatures were retrieved from PubMed,Embase,The Cochrane Library,CBM,CNKI,VIP and Wanfang Data until March 25,2021.Two independent researchers evaluated the included literatures and extracted the data to analysis,RevMan5.3 and STATA13 software were used to calculate the sensitivity(Sen)and specificity(Spe)of the swab sampling methods to determine whether DF were winfected pathogenic bacteria and the consistence of the pathogenic microorganisms,and subgroup analysis was conducted according to the depth of infection.To compare the difference between the two methods,t test was used to analyze the number of pathogens and Chi-square test was used to analyze the classification of Gram stain typing.Results A total of 725 samples from 6 studies were included.In the evaluation of swab sampling method to determine whether DF infected pathogenic bacteria,the combined SEN=0.94[95%CI(0.82-0.98)],the combined SPE=0.59[95%CI(0.33-0.81)].While the combined SEN=0.71[95%CI(0.46-0.87)],the combined SPE=0.28[95%CI(0.14-0.49)],AUC=0.45[95%CI(0.41-0.60)],when swab sampling method was used to determine pathogenic microorganisms.In the subgroup analysis,the sensitivity of the shallow infection group was higher than that of the deep infection group.There was no significant difference between the two sampling methods in the number of pathogens obtained by Gram stain typing.Conclusions Swab sampling is of high diagnostic value in determining whether pathogenic bacteria are infected,but its accuracy in identifying DF infection of pathogenic microorganisms is poor.Swab sampling method cannot completely replace tissue sampling method.