肝移植术后多重耐药菌感染危险因素的Meta分析

Meta-analysis of risk factors for multi-drug resistant organisms infections after liver transplantation

目的系统评价肝移植患者术后多重耐药菌(MDROs)感染的影响因素,为预防和控制感染提供参考依据。方法计算机检索PubMed、Medline、Embase、Wed of Science、中国生物医学文献服务数据库、万方数据库、中国知网和维普网收录的关于肝移植术后MDROs感染影响因素的相关文献,检索时限为从建库至2023年9月1日,语种限定为中文和英文。2名评价员筛选文献并提取资料,使用纽卡斯尔-渥太华量表对最终纳入文献进行质量评价,采用RevMan5.4软件进行Meta分析。结果最终共纳入17篇文献,其中病例对照研究5篇,队列研究12篇。Meta分析结果显示,Ⅱ~Ⅳ级肝性脑病、肾功能不全、移植前耐药菌定植、执行留置气管操作、气管留置时间≥48 h、气管留置时间≥72 h、ICU住院时间、移植前使用抗菌药物、术后胆汁泄漏、术后真菌培养阳、移植后再次手术、血液透析是肝移植术后MDROs感染的危险因素(P<0.05)。结论肝移植患者术后发生MDROs感染的影响因素较多,医务人员应警惕和识别相关危险因素,做好感染风险评估,针对危险因素采取预防与控制措施,从而改善肝移植患者的预后。

Objective To systematically evaluate influencing factors of multi-drug resistant organisms(MDROs)infection in patients undergoing liver transplantation and to provide reference for infection prevention and control.Methods The relevant literatures on the influencing factors of MDROs infection after liver transplantation included in PubMed,Medline,Embase,Wed of Science,China Biology Medicine disc,Wanfang Database,China National Knowledge Infrastructure and VIP were searched by computer,and the search time was from the establishment of databases to September 1,2023.The languages were limited to Chinese and English.Two evaluators screened literature and extracted data,and used The Newcastle Ottawa Scale to evaluate the quality of the final included literature.Meta-analysis was performed using RevMan5.4 software.Results Finally,a total of 17 literatures were included,including five case-control studies and 12 cohort studies.The results of Meta-analysis showed that ClassⅡtoⅣhepatic encephalopathy,renal insufficiency,colonization of drug-resistant organisms before transplantation,performing tracheal intubation,tracheal intubation time greater than or equal to 48 h,tracheal intubation time greater than or equal to 72 h,length of ICU stay,use of antibiotics before transplantation,postoperative bile leakage,postoperative fungal culture of positivity,reoperation after transplantation and hemodialysis were risk factors for MDROs infection after liver transplantation(P<0.05).Conclusions There are many influencing factors for multi-drug resistant organisms infection in liver transplant patients after surgery.Medical staff should be vigilant and identify relevant risk factors,conduct infection risk assessment and take preventive and control measures based on risk factors to improve the prognosis of liver transplant patients.