多重耐药鲍曼不动杆菌医院感染危险因素荟萃分析

Metaanalysis on risk factors for healthcareassociated infection with multidrugresistant Acinetobacter baumannii

摘要:

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。

Abstract:

ObjectiveTo systematically evaluate risk factors for healthcareassociated infection(HAI) with multidrugresistant Acinetobacter baumannii (MDRAB), so as to provide scientific basis for formulating MDRAB prevention and intervention strategies. MethodsLiteratures at home and abroad were searched, RevMan 5.3 statistical software was used for meta analysis of the included literature data. ResultsA 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 antimicrobial 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 procedures：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 factors 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］）. ConclusionAntimicrobial 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.