【摘要】 目的系统评价新生儿碳青霉烯类耐药肠杆菌科细菌定植或感染的危险因素。方法计算机检索PubMed、EMbase、The Cochrane Library、CBM、WanFang Data、VIP和CNKI数据库,搜集有关新生儿碳青霉烯类耐药肠杆菌科细菌定植或感染危险因素的队列研究或病例-对照研究,检索时限均为建库至2020年5月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入9个病例-对照研究,包括759例患儿。Meta分析结果显示,产妇因素中胎盘早剥[OR=6.25,95%CI(1.47,26.61),P=0.01]、胎膜早破[OR=5.62,95%CI(2.63,12.00),P<0.000 01]、妊娠高血压[OR=2.04,95%CI(1.49,2.80),P<0.000 01]、产前使用碳青霉烯类药物[OR=1.77,95%CI(1.11,2.81),P=0.017],新生儿因素中早产[OR=1.96,95%CI(1.06,3.61),P=0.03]、机械通气[OR=2.14,95%CI(1.01,4.55),P=0.05]、手术史[OR=14.17,95%CI(2.46,81.70),P=0.003]、脐静脉置管[OR=1.93,95%CI(1.20,3.11),P=0.007]、经外周静脉穿刺中心静脉置管[OR=4.30,95%CI(1.86,9.93),P=0.000 6]、鼻饲[OR=4.37,95%CI(1.44,13.29),P=0.009]、碳青霉烯类药物使用[OR=3.04,95%CI(1.91,4.84),P<0.000 01]、入住NICU[OR=2.78,95%CI(1.79,4.33),P<0.000 01]均是新生儿碳青霉烯类耐药肠杆菌科细菌定植或感染的危险因素;而母乳喂养[OR=0.30,95%CI(0.13,0.70),P=0.005]为保护因素。结论当前证据表明产妇胎盘早剥、胎膜早破、妊娠高血压、产前使用碳青霉烯类抗菌药及新生儿早产、机械通气、手术史、脐静脉置管、经外周静脉穿刺中心静脉置管、鼻饲、碳青霉烯类药物使用、入住NICU可能是新生儿碳青霉烯类耐药肠杆菌科细菌定植或感染的危险因素;母乳喂养可能是新生儿碳青霉烯类耐药肠杆菌科细菌定植或感染的保护因素。受纳入研究数量与质量限制,上述结论需要更多高质量研究予以验证。更多还原

【Abstract】 Objectives To systematically review the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates. Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect cohort or case-control studies on the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates from inception to May 2020. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies, and meta-analysis was performed by RevMan5.3 software. Results A total of 9 case-control studies involving 759 patients were included.The results of meta-analysis showed that, maternal factors like placental abruption(OR=6.25, 95%CI 1.47 to 26.61,P=0.01), premature rupture of fetal membranes of parturient(OR=5.62, 95%CI 2.63 to 12.00, P<0.000 01), pregnancyinduced hypertension(OR=2.04, 95%CI 1.49 to 2.80, P<0.000 01), carbapenem antibiotics used in mothers(OR=1.77,95%CI 1.10 to 2.81, P=0.017), neonatal factors like premature delivery(OR=1.96, 95%CI 1.06 to 3.61, P=0.03), mechanical ventilation(OR=2.14, 95%CI 1.01 to 4.55, P=0.05), surgical procedure(OR=14.17, 95%CI 2.46 to 81.70, P=0.003),umbilical vein catheter(OR=1.93, 95%CI 1.20 to 3.11, P=0.007), peripherally inserted central catheter(OR=4.30, 95%CI1.86 to 9.93, P=0.000 6), nasogastric feeding(OR=4.37, 95%CI 1.44 to 13.29, P=0.009), use of carbapenems(OR=3.04,95%CI 1.91 to 4.84, P<0.000 01), and admission to NICU(OR=2.78, 95%CI 1.79 to 4.33, P<0.000 01) were the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates. Breastfeeding(OR=0.30, 95%CI 0.13 to0.70, P=0.005) was the protective factor of carbapenem-resistant enterobacteriaceae colonization or infection in neonates.Conclusions The current evidence shows that maternal factors like placental abruption, premature rupture of fetal membranes, pregnancy-induced hypertension, carbapenem antibiotics used in mothers, and neonatal factors like premature delivery, mechanical ventilation, surgical procedure, umbilical vein catheter, peripherally inserted central catheter, nasogastric feeding, use of carbapenems, and admission to NICU are the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates; while breastfeeding is the protective factor of carbapenemresistant enterobacteriaceae colonization or infection in neonates. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the conclusions.更多还原