糖尿病足创面耐甲氧西林金黄色葡萄球菌检出率的Meta分析

Prevalence of methicillin-resistant Staphylococcus aureus in diabetic foot: a meta-analysis

目的系统评价糖尿病足创面耐甲氧西林金黄色葡萄球菌(MRSA)的检出率。方法检索中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据知识服务平台(Wanfang)、维普数据库(VIP)、美国国立医学图书馆数据库(PubMed)、医学文摘数据库(EMbase)、循证医学数据库(the Cochrane Library)、科学引文数据库(Web of Science)、Scopus、Ovid及Proquest从建库至2022年5月16日所有关于糖尿病足创面MRSA检出率的文献。提取相关数据, 采用Stata 17.0统计软件, 应用随机效应模型合并分析MRSA占总菌株、革兰阳性菌(GPB)及金黄色葡萄球菌(SA)的检出率, 并且按地域和时间[10年前亚组(1998—2011年)和近10年亚组(2012—2022年)]分析糖尿病足创面MRSA检出率的地域和时间差异。结果最终纳入31篇文献, 9 021例研究对象, 分离菌株12 262株。糖尿病足创面MRSA占总分离菌株检出率为8.00%(95%CI 6.77%~9.33%), 按地域分布, 欧洲的检出率为10.09%(95%CI 7.22%~13.38%), 亚洲(除中国外)的为7.77%(95%CI 5.60%~10.25%), 非洲的为7.74%(95%CI 6.08%~9.58%), 中国的为7.31%(95%CI 4.53%~10.65%), 按时间分布, 10年前亚组的为8.47%(95%CI 6.34%~10.87%), 近10年亚组的为7.71%(95%CI 6.23%~9.33%)。糖尿病足创面MRSA占GPB检出率为18.96%(95%CI 16.65%~21.37%), 按地域分布, 欧洲的为19.00%(95%CI 14.23%~24.26%), 亚洲(除中国外)的为19.68%(95%CI 15.32%~24.41%), 非洲的为22.29%(95%CI 13.91%~31.94%), 中国的为17.38%(95%CI 13.63%~21.47%), 按时间分布, 10年前亚组的为20.64%(95%CI 16.71%~24.85%), 近10年亚组的为17.98%(95%CI 15.20%~20.93%)。糖尿病足创面MRSA占SA检出率的为36.97%(95%CI 32.72%~41.33%), 按地域分布, 欧洲的为39.14%(95%CI 28.83%~49.95%), 亚洲(除中国外)的为39.31%(95%CI 30.12%~48.88%), 非洲的为34.52%(95%CI 20.75%~49.73%), 中国的为37.03%(95%CI 28.99%~45.43%), 按时间分布, 10年前亚组的为40.56%(95%CI 33.45%~47.86%), 近10年亚组的为34.84%(95%CI 29.53%~40.34%)。结论糖尿病足创面MRSA占总分离菌株、GPB及SA的检出率因地域的不同而有所差异, 虽然近10年较10年前有下降趋势, 但MRSA仍是糖尿病足常见的多重耐药菌之一。

Objective To systematically evaluate the prevalence of methicillin-resistant Staphylococcus aureus(MRSA)in diabetic foot.Methods We searched the China national knowledge infrastructure(CNKI),China biomedical literature(CBM),Wanfang,VIP,PubMed,Web of Science,EmBase,the Cochrane Library,Scopus,Ovid and Proquest databases for literature on the detection rate of MRSA in diabetic foot patients from the inception of the database to May 16,2022.Data were extracted from the included literature.In order to analyze the differences of MRSA detection rate in diabetic foot wounds in different regions and time,the detection rate of MRSA in total bacterial isolates,Gram-positive bacteria(GPB)and Staphylococcus aureus(SA)were analyzed by random effect model with Stata 17.0.Meanwhile,the detection rate of MRSA between the subgroup of 10 years ago(1998—2011)and the subgroup of last 10 years(2012—2022)were evaluated.ResultsThis study included 31 publications,9021 patients and 12262 bacterial isolates.The detection rate of MRSA in total bacterial isolates was 8.00%(95%CI 6.77%-9.33%).It varied in different regional subgroups with Europe 10.09%(95%CI 7.22%-13.38%),Asia(other regions except China)7.77%(95%CI 5.60%-10.25%),Africa 7.74%(95%CI 6.08%-9.58%)and China 7.31%(95%CI 4.53%-10.65%).The detection rate of MRSA in total bacterial isolates was 8.47%(95%CI 6.34%-10.87%)in the subgroup from 10 years ago and 7.71%(95%CI 6.23%-9.33%)in the subgroup from the last 10 years.The detection rate of MRSA in GPB was 18.96%(95%CI 16.65%-21.37%).In different regional subgroups,the detection rate of MRSA in GPB was 19.00%(95%CI 14.23%-24.26%)in Europe,19.68%(95%CI 15.32%-24.41%)in Asia(other regions except China),22.29%(95%CI 13.91%-31.94%)in Africa and 17.38%(95%CI 13.63%-21.47%)in China.In different time subgroups,the detection rate of MRSA in GPB was 20.64%(95%CI 16.71%-24.85%)in the subgroup from 10 years ago and 17.98%(95%CI 15.20%-20.93%)in the subgroup from the last 10 years.The detection rate of MRSA in SA was 36.97%(95%CI 32.72%-41.33%).In different regional subgroups,the detection rate of MRSA in SA in Europe,Asia(other regions except China),Africa and China was 39.14%(95%CI 28.83%-49.95%),39.31%(95%CI 30.12%-48.88%),34.52%(95%CI 20.75%-49.73%)and 37.03%(95%CI 28.99%-45.43%),respectively.In different time subgroups,the detection rate of MRSA in SA was 40.56%(95%CI 33.45%-47.86%)in the subgroup from 10 years ago and 34.84%(95%CI 29.53%-40.34%)in the subgroup from the last 10 years.Conclusions The detection rate of MRSA in total bacterial isolates,GPB and SA varies with different regions.Although there has been a decrease in the last 10 years compared to 10 years ago,MRSA is still one of the most common multidrug-resistant bacteria in the diabetic foot,which should not be underestimated.