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

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.