重症监护病房患者多重耐药菌感染危险因素的Meta分析

Risk Factors of Multidrug Resistant Organisms Infections in ICU Patients:A Meta-analysis

目的分析重症监护病房(ICU)患者多重耐药菌(MDRO)感染的相关危险因素,探索针对性的防控措施。方法计算机检索Embase、Website of Science、the Cochrane Library、PubMed、中国知网、万方、维普等数据库从建库至2022年10月26日ICU患者MDRO感染危险因素的病例对照研究与队列研究。并且使用RevMan 5.3版软件进行危险因素的Meta分析。结果共纳入文献32篇,研究对象10985例,文献质量为中高等。本研究Meta分析结果显示性别[OR=1.21,95%CI=(1.08,1.36),P=0.002]、ICU住院时间[WMD=5.36,95%CI=(3.99,6.73),P<0.00001]、总住院时间[WMD=8.96,95%CI=(6.51,11.41),P<0.00001]、高血压[OR=1.33,95%CI=(1.10,1.60),P=0.003]、肾功能异常[OR=1.69,95%CI=(1.33,2.16),P<0.00001]、低蛋白血症[OR=1.87,95%CI=(1.51,2.32),P<0.00001]、机械通气[OR=2.26,95%CI=(1.18,4.33),P=0.01]、机械通气时间[WMD=8.83,95%CI=(2.52,15.14),P=0.006]、动静脉置管[OR=1.46,95%CI=(1.23,1.72),P<0.0001]、安置尿管[OR=1.71,95%CI=(1.25,2.36),P<0.00001]、消化道置管[OR=0.10,95%CI=(0.03,0.18),P=0.008]、抗菌药物种类≥3种[OR=4.27,95%CI=(2.06,8.85),P<0.00001]、使用碳青霉烯类抗生素[OR=4.09,95%CI=(3.00,5.58),P<0.00001]、使用第3代头孢菌素[OR=1.63,95%CI=(1.15,2.33),P=0.007]、使用喹诺酮类抗菌药物[OR=1.86,95%CI=(1.42,2.44),P<0.00001]、使用氨基苷类抗生素[OR=1.99,95%CI=(1.49,2.67),P<0.00001]、使用哌拉西林-他唑巴坦[OR=2.94,95%CI=(1.56,5.54),P=0.0009]、使用糖肽类抗生素[OR=3.78,95%CI=(2.48,5.78),P<0.00001]、使用镇静剂[OR=3.25,95%CI=(2.06,5.14),P<0.00001]、使用抑酸药[OR=1.51,95%CI=(1.06,2.16),P=0.02]是ICU患者MDRO感染的危险因素。结论ICU患者MDRO感染与性别、ICU住院时间、慢性肺部疾病、总住院时间、高血压、肾功能异常、低蛋白血症、机械通气、机械通气时间、动静脉置管、安置尿管、消化道置管、抗菌药物种类≥3种、使用碳青霉烯类抗生素、使用第3代头孢菌素、使用喹诺酮类抗菌药物、使用氨基苷类抗生素、使用哌拉西林-他唑巴坦、使用糖肽类抗生素、使用镇静剂、使用抑酸药等多种因素相关。针对性地对基本情况、合并症、侵入性操作、抗菌药物与其他治疗性药物的使用等多方面因素进行控制,对ICU患者采取合理措施,能够降低ICU患者MDRO的感染风险。

Objective For more focused prevention and management,this investigation examines the risk factors for multidrug resistant organisms(MDRO)infections in intensive care unit(ICU)patients.Methods Case-control studies and cohort studies of risk factors for MDRO infection in ICU patients were searched in the Embase,Website of Science,Cochrane Library,PubMed,CNKI,WanFang,and VIP databases from their start to October 26,2022.The Meta-analysis was carried out with RevMan 5.3.Results A total of 32 papers were included,with 10985 cases studied,with the quality of the literature rated as moderate to high.The results of Meta-analysis of this study showed that gender[OR=1.21,95%CI=(1.08,1.36),P=0.002],ICU length of stay[WMD=5.36,95%CI=(3.99,6.73),P<0.00001],total length of stay[WMD=8.96,95%CI=(6.51,11.41),P<0.00001],hypertension[OR=1.33,95%CI=(1.10,1.60),P=0.003],abnormal renal function[OR=1.69,95%CI=(1.33,2.16),P<0.00001],hypoproteinemia[OR=1.87,95%CI=(1.51,2.32),P<0.00001],mechanical ventilation[OR=2.26,95%CI=(1.18,4.33),P=0.01],duration of mechanical ventilation[WMD=8.83,95%CI=(2.52,15.14),P=0.006],arteriovenous placement[OR=1.46,95%CI=(1.23,1.72),P<0.0001],placement of urinary catheter[OR=1.71,95%CI=(1.25,2.36),P<0.00001],gastrointestinal tube placement[OR=0.10,95%CI=(0.03,0.18),P=0.008],antimicrobial drug type≥3[OR=4.27,95%CI=(2.06,8.85),P<0.00001],use of carbapenem antibiotics[OR=4.09,95%CI=(300,5.58),P<0.00001],the use of the third-generation cephalosporin[OR=1.63,95%CI=(1.15,2.33),P=0.007],the use of quinolone antibacterials[OR=1.86,95%CI=(1.42,2.44),P<0.00001],the use of aminoglycoside antibiotics[OR=1.99,95%CI=(1.49,2.67),P<0.00001],use of piperacillin-tazobactam[OR=2.94,95%CI=(1.56,5.54),P=0.0009],use of glycopeptide antibiotics[OR=3.78,95%CI=(2.48,5.78),P<0.00001],use of sedatives[OR=3.25,95%CI=(2.06,5.14),P<0.00001],and use of acid suppressants[OR=1.51,95%CI=(1.06,2.16),P=0.02]are risk factors for MDRO infection in ICU patients.Conclusion MDRO infections in ICU patients are associated with gender,duration of ICU stay,chronic lung disease,total length of stay,hypertension,abnormal renal function,hypoproteinemia,mechanical ventilation,duration of mechanical ventilation,arteriovenous placement,placement of urinary catheters,gastrointestinal placement,type of antimicrobial drugs≥3,use of carbapenem antibiotics,use of third-generation cephalosporin,use of quinolone antibacterials,use of aminoglycoside antibiotics,use of piperacillin-tazobactam,use of glycopeptide antibiotics,use of sedatives,use of acid suppressants,and other factors.Targeted controls of different factors such as underlying diseases,comorbidities,invasive procedures performed,and the use of antimicrobial medications and other therapeutic pharmaceuticals could limit the risk of infection in MDRO in ICU patients.