氯己定擦浴预防ICU病人多重耐药菌感染效果的Meta分析

Effect of chlorhexidine bathing in preventing multi-drug-resistant bacterial infections in ICU patients:a Meta-analysis

目的:系统评价氯己定全身擦浴对重症监护室(ICU)病人多重耐药菌感染的预防效果。方法:检索the Cochrane Library、PubMed、Web of Science、EMbase、中国知网、万方数据库、维普数据库、中国生物医学文献数据库中关于氯己定全身擦浴预防ICU病人多重耐药菌感染效果的中英文文献。由2名研究者根据纳入与排除标准独立筛选文献、质量评价及提取资料,采用Stata 16.0软件进行Meta分析。结果:最终纳入11项研究共23090例病人。Meta分析结果显示,与常规温水或肥皂水擦浴比较,氯己定能降低ICU病人多重耐药菌感染(OR=0.770,P<0.001)。其中氯己定全身擦浴能降低耐万古霉素肠球菌(VRE)(OR=0.664,P=0.004)及耐碳青霉烯类铜绿假单胞菌(CRPA)(OR=0.442,P=0.034)的感染发生风险,但不能降低耐甲氧西林金黄色葡萄球菌(MRSA)(OR=0.852,P=0.193)及耐碳青霉烯类鲍曼不动杆菌(CRAB)的感染发生风险(OR=0.888,P=0.537)。结论:现有证据显示,氯己定全身擦浴能降低ICU病人多重耐药菌感染,但仅对部分耐药菌有效。

Objective:To systematically evaluate the preventive effect of chlorhexidine bathing on multidrug-resistant bacterial infections in ICU patients.Methods:Chinese and English literature on the effectiveness of chlorhexidine bathing in preventing multidrug-resistant bacterial infections in ICU patients were retrieved from the Cochrane Library,PubMed,Web of Science,EMbase,CNKI,WanFang Database,VIP database,and CBM.Two researchers independently screened the literature,evaluated quality,extracted data according to the inclusion and exclusion criteria,and used Stata 16.0 software to perform Meta-analysis.Results:A total of 11 studies involving 23090 patients were finally included.Meta-analysis results showed that compared with conventional warm water or soapy water bathing,chlorhexidine can reduce multi-drug-resistant bacterial infections in ICU patients(OR=0.770,P<0.001),and the difference was statistically significant.Among them,chlorhexidine whole-body bathing can reduce vancomycin-resistant enterococci(VRE)(OR=0.664,P=0.004)and carbapenem-resistant Pseudomonas aeruginosa(CRPA)(OR=0.442,P=0.034).Still,it cannot reduce the risk of infection with methicillin-resistant Staphylococcus aureus(MRSA)(OR=0.852,P=0.193)and carbapenem-resistant acinetobacter baumannii(CRAB)(OR=0.888,P=0.537).Conclusions:Existing evidence shows that chlorhexidine bathing could reduce multi-drug-resistant bacterial infections in ICU patients,but it is only effective against some drug-resistant bacteria.