【摘要】 目的:采用Meta分析方法评价耐碳青霉烯类铜绿假单胞菌(CRPA)感染的危险因素。方法:计算机检索PubMed、The Cochrane Library、Embase、CNKI、WanFang Data和VIP数据库中有关CRPA感染危险因素的研究,检索时限均从建库至2018年1月。采用Rev Man 5.3软件对纳入的研究进行Meta分析。根据不同区域研究人群进行亚组分析,发现纳入研究的异质性来源。结果:22篇研究(6 097例患者)符合纳入标准。Meta分析结果显示,病例组(发生CRPA感染)的机械通气[OR=1.64,95%CI(1.42,1.89)],使用碳青霉烯类[OR=7.15,95%CI(3.52,14.52)]、亚胺培南[OR=7.89,95%CI(3.90,15.93)]、氟喹诺酮类[OR=2.88,95%CI(2.12,3.90)]、哌拉西林/他唑巴坦[OR=4.46,95%CI(2.33,8.53)]、万古霉素[OR=5.39,95%CI(3.94,7.37)],入住ICU[OR=2.88,95%CI(2.12,3.90)],住院天数[WMD=6.53,95%CI(1.33,11.73)]等8个危险因素的分布与未发生CRPA感染的对照组比较,差异均有统计学意义(P<0.05)。亚组分析不同区域研究人群使用碳青霉烯类、亚胺培南的结果,其中亚洲人群存在高度异质性分别为(P≤0.1,I2=87%)、(P≤0.1,I2=85%)。结论:针对存在高危因素的患者,应结合危险因素及早采取预防措施,降低CRPA感染的发生率。更多还原

【Abstract】 Objective: To systematically evaluate the risk factors for infections caused by carbapenem-resistant Pseudomonas aeruginosa. Methods: Literature regarding the risk factors of CRPA infection were searched in Pub Med,The Cochrane Library,Embase,CNKI,VIP and Wanfang database. The retrieval time was from inception to January 2018.Meta-analysis was performed by Rev Man 5. 3 software. Subgroup analysis was carried out according to the population of different regions,and the sources of heterogeneity were found. Results: 22 studies(n = 6 097) met the inclusion criteria. The results of Meta analysis,8 risk factors of two groups were statistically significant: mechanical ventilation [OR = 1. 64,95%CI(1. 42,1. 89) ],use of carbapenems [OR = 7. 15,95% CI(3. 52,14. 52) ],imipenem [OR = 7. 89,95% CI(3. 90,15. 93) ],fluoroquinolone [OR = 2. 88,95% CI(2. 12,3. 90) ],piperacillin tazobactam [OR = 4. 46,95% CI(2. 33,8. 53) ],vancomycin [OR = 5. 39,95% CI(3. 94,7. 37) ],in ICU [OR = 2. 88,95% CI(2. 12,3. 90) ],days of hospitalization [WMD = 6. 53,95% CI(1. 33,11. 73) ](P < 0. 001). Subgroup analysis results of risk factors using carbapenems,imipenem,in which the Asian population was highly heterogeneous(P≤0. 1,I2= 87%),(P≤0. 1,I2= 85%).Conclusion: For high-risk patients,it should be combined with risk factors and early take preventive measures to reduce the incidence of CRPA infection.更多还原