摘要
目的系统评价多重耐药鲍曼不动杆菌(MDRAB)血流感染及感染后死亡危险因素,为各级医疗机构预防MDRAB血流感染及降低感染后死亡率提供依据。方法计算机检索中国学术期刊全文数据库(CNKI)、万方数据库(Wanfang Data)、维普中文期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、Embase等,检索时限为建库至2022年10月31日,收集国内外MDRAB血流感染及感染后死亡危险因素的病例对照研究,采用RevMan 5.3软件进行Meta分析。结果共纳入病例对照研究13篇,涉及感染危险因素32个,死亡危险因素25个。结果显示合并实体瘤、恶性肿瘤、呼吸衰竭、慢性心功能不全、肺炎,入住ICU,机械通气、气管切开、气管插管、留置导尿管、连续性血液净化、留置引流管,感染前使用喹诺酮类、碳青霉烯类、抗真菌药物,感染前使用抗生素≥2种,激素治疗和抗生素使用不当MDRAB血流感染组和非多重耐药鲍曼不动杆菌(N-MDRAB)组相比,差异有统计学意义(P<0.05);合并恶性肿瘤、慢性肾脏疾病、慢性肝脏疾病、免疫抑制状态,合并基础疾病≥3种,急性生理慢性健康评分(APACHE-Ⅱ)评分高,机械通气MDRAB血流感染后死亡组和生存组相比,差异有统计学意义(P<0.05)。结论MDRAB血流感染及感染后死亡的危险因素多,临床诊疗活动中应重视患者基础疾病,严格把握侵入性操作指征,合理使用抗菌药物和免疫抑制类药物,动态评估患者生命体征,根据危险因素制定感控策略,从而降低MDRAB血流感染率和感染后死亡率。
Objective To systematically evaluate the risk factors of blood flow infection and death after infection of multidrugresistant Acinetobacter baumannii(MDRAB),so as to provide basis for medical institutions at all levels to prevent blood flow infection of MDRAB and reduce mortality after infection.Methods Data were electronically searched from CNKI,Wanfang,VIP,CBM,PubMed,Embase from the date of establishment to October 31,2022 for the case control studies on blood flow infection of multiple drug resistant Acinetobacter baumannii and risk factors of death after infection were collected at home and abroad.RevMan 5.3 software was used for Meta-analysis.The risk factors of MDRAB bloodstream infection and death after infection were obtained.Results A total of 13 case-control studies,involved 32 risk factors of infection and 25 risk factors of death.The results showed that patients with solid tumors,malignant tumors,respiratory failure,chronic cardiac insufficiency,pneumonia,admitted to ICU,mechanical ventilation,tracheotomy,tracheal intubation,indwelling catheter,continuous blood purification,indwelling drainage tube,used quinolones,carbapenems,and antifungal drugs before infection,used≥two kinds of antibiotics before infection,improper hormone treatment and antibiotic use MDRAB blood flow infection group compared with non-multidrug-resistant Acinetobacter baumannii(N-MDRAB)group.The difference was statistically significant(P<0.05).The patients with malignant tumor,chronic kidney disease,chronic liver disease,immunosuppressive state,and more than 3 basic diseases were combined.The acute physiology and chronic health evaluationⅡ(APACHE-II)score was high.The difference between the death group and the survival group after mechanical ventilation MDRAB blood flow infection was statistically significant(P<0.05).Conclusion There are many risk factors for blood flow infection and death after infection of MDRAB.In clinical diagnosis and treatment,we should pay attention to the basic diseases of patients,strictly grasp the invasive operation indications,reasonably use antibacterial drugs and immunosuppressive drugs,dynamically evaluate the vital signs of patients,and formulate corresponding sensing strategies according to the risk factors,so as to reduce the blood flow infection rate and death rate after infection of MDRAB.
作者
张杰
谢星星
范小冬
骆洪
杨明
ZHANG Jie;XIE Xingxing;FAN Xiaodong;LUO Hong;YANG Ming(Department of Pharmacy,Nanbu County People's Hospital,Nanchong 637300,China;Department of Pharmacy,Ya'an People's Hospital,Ya'an 625000,China;Department of Pharmacy,Xichong County People's Hospital,Nanchong 637200,China;Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China)
出处
《药物评价研究》
CAS
2023年第3期663-670,共8页
Drug Evaluation Research
基金
四川省医院协会2022年青年药师科研专项资金项目(22045)
四川省医学会(恒瑞)科研基金专项科研课题(2021HR26)
南充市科技计划项目(22YFZJZC0047)
雅安市重点科技计划-应用技术研究与开发项目(22KJJH0039)。
关键词
鲍曼不动杆菌
多重耐药
血流感染
危险因素
病例对照研究
系统评价
Acinetobacter baumannii
multidrug resistance
blood flow infection
risk factors
case control studies
system evaluation
