多重耐药鲍曼不动杆菌医院感染危险因素荟萃分析

摘要

Objective To systematically evaluate risk factors for healthcare-associated infection(HAI)with multi-drug-resistant Acinetobacterbaumannii (MDRAB),so as to provide scientific basis for formulating MDRAB pre-vention and intervention strategies. Methods Literatures at home and abroad were searched,RevMan 5.3 statisti-cal software was used for meta analysis of the included literature data. Results A total of 21 papers were included, 8 in English and 13 in Chinese,35 risk factors were analyzed,20 of which were significantly different(all P<0.05),which included in 4 categories:① Related factors for antimicrobial use:use of antimicrobial agents prior to isolation of MDRAB(OR,12.87 [95% CI,5.14-32.21]),duration of antimicrobial use(MD,6.99 [95% CI, 2.21-11.78]),types of used antimicrobial agents (MD,1.07 [95% CI,0.60-1.54]),combined use of antimi-crobial agents(OR,4.16 [95% CI,2.63-6.57]),carbapenems use(OR,3.95 [95% CI,2.54-6.13]),use of third and above generation cephalosporins(OR,2.48 [95% CI,1.90-3.24]);② Related factors for invasive pro-cedures:mechanical ventilation(OR,4.30 [95% CI,3.03- 6.10]),endotracheal intubation/tracheotomy(OR, 4.17 [95% CI,2.41-7.22]),urinary catheterization(OR,2.35 [95% CI,1.42-3.88]),deep venous puncture (OR,2.18 [95% CI,1.14-4.16]),drainage catheterization(OR,2.06 [95% CI,1.19-3.58]);③Related fac-tors for intensive care unit (ICU):ICU admission(OR,5.60 [95% CI,2.73-11.48]),length of ICU stay(MD, 4.21 [95% CI,0.72-7.71]);④ Other factors:heart disease(OR,0.71 [95% CI,0.55-0.93]),tumor(OR, 0.67 [95% CI,0.48-0.95]),pancreatitis(OR,2.04 [95% CI,1.11-3.76]),mixed infection(OR,2.57 [95%CI,1.78-3.71]),length of hospital stay(MD,5.92 [95% CI,3.61-8.23]),APACHE II score(MD,4.56 [95% CI,1.94-7.18]),use of glucocorticoid(OR,2.18 [95% CI,1.21-3.90]). Conclusion Antimicrobial use,invasive operation,ICU-related factors are the main risk factors for MDRAB HAI,the relevant treatment and nursing intervention strategies should be formulated based on risk factors to prevent and reduce MDRAB infection.%目的 系统评价多重耐药鲍曼不动杆菌(MDRAB)医院感染的危险因素,为制定MDRAB预防策略提供科学依据.方法 检索国内外相关文献,采用RevMan 5.3统计软件对纳入的文献资料进行荟萃分析.结果 共纳入21篇文献,其中英文8篇,中文13篇,分析35个危险因素,其中20个差异有统计学意义(均P<0.05),①抗菌药物使用相关因素:检出前使用抗菌药物(OR=12.87,95%CI=5.14~32.21)、使用抗菌药物的时间(MD=6.99,95%CI=2.21~11.78)、抗菌药物种类(MD=1.07,95%CI=0.60~1.54)、联合使用抗菌药物(OR=4.16,95%CI=2.63~6.57)、使用碳青霉烯酶类药物(OR=3.95,95%CI=2.54~6.13)和第三代以上头孢菌素类(OR=2.48,95%CI=1.90~3.24);②侵入性操作相关因素:机械通气(OR=4.30,95%CI=3.03~6.10)、气管插管/切开(OR=4.17,95%CI=2.41~7.22)、留置导尿管(OR=2.35,95%CI=1.42~3.88)、深静脉穿刺(OR=2.18,95%CI=1.14~4.16)、留置引流管(OR=2.06,95%CI=1.19~3.58);③重症监护病房(ICU)相关因素:入住ICU(OR=5.60,95%CI=2.73~11.48)、住ICU的时间(MD=4.21,95%CI=0.72~7.71);④其他因素:心脏病(OR=0.71,95%CI=0.55~0.93)、肿瘤(OR=0.67,95%CI=0.48~0.95)、胰腺炎(OR=2.04,95%CI=1.11~3.76)、混合感染(OR=2.57,95%CI=1.78~3.71)、住院时间(MD=5.92,95%CI=3.61~8.23)、APACHE II评分(MD=4.56,95%CI=1.94~7.18)、使用糖皮质激素(OR=2.18,95%CI=1.21~3.90).结论 抗菌药物的使用、侵入性操作、ICU相关因素是MDRAB医院感染的主要危险因素,应根据危险因素制定相关的治疗和护理干预策略,预防和减少MDRAB感染.