ICU病人多重耐藥菌感染危險因素的Meta分析

Risk factors of multidrug-resistant bacteria infection in ICU patients：a Meta-analysis

YAO Yufei，SUN Haichao，HU YiSchool of Nursing·School of Public Health，Yangzhou University，Jiangsu 225000 ChinaCorresponding Author HU Yi，E-mail：18951058689@189.cn

Abstract Objective：To systematically evaluate the risk factors for the development of multidrug-resistant organism（MDRO） infections in ICU patients.Methods：Computer searched of publicly available studies on risk factors for MDRO infection in ICU patients on CNKI，WanFang Database，VIP，CBM，PubMed，EMbase，the Cochrane Library，Web of Science，and CIHANL.The data of the included literature were extracted，the Newcastle-Ottawa Scale （NOS） was used to evaluate the quality of the included literature，and RevMan 5.4.1 was used for Meta-analysis.Results：A total of 30 articles with 18 302 patients were included.Meta-analysis results showed that APACHE Ⅱ score，antibiotic therapy，diabetes mellitus，chronic lung disease，mechanical ventilation，duration of ICU stay，duration of indwelling catheterization，and central venous placement were risk factors for MDRO infection in ICU patients（Plt;0.05）.Conclusion：Current evidence shows that there are many risk factors for MDRO infection in ICU patients，and targeted preventive and control measures should be taken to reduce the occurrence of MDRO infection according to the different conditions of patients.

Keywords intensive care unit，ICU;multidrug-resistant organism，MDRO;infection;risk factors;Meta-analysis

摘要 目的：系統評價重癥監護室（ICU）病人發生多重耐藥菌（MDRO）感染的危險因素。方法：計算機檢索中國知網、萬方數據庫、維普數據庫、中國生物醫學文獻數據庫、PubMed、EMbase、the Cochrane Library、Web of Science、CIHANL公開發表的ICU病人MDRO感染危險因素的研究。提取納入文獻的資料，采用紐卡斯爾-渥太華量表（NOS）進行質量評價，采用RevMan 5.4.1軟件進行Meta分析。結果：共納入30篇文獻，涉及18 302例病人。Meta分析結果顯示，急性生理與慢性健康評分、抗生素治療、糖尿病、慢性肺部疾病、機械通氣、ICU住院時間、留置導尿時間、中心靜脈置管等均為ICU病人MDRO感染的危險因素（P＜0.05）。結論：現有證據表明，ICU病人感染MDRO的危險因素較多，應根據病人的不同情況，采取有針對性的預防和控制措施，減少MDRO感染的發生。

關鍵詞 重癥監護室；多重耐藥菌；感染；危險因素；Meta分析

doi：10.12102/j.issn.2095-8668.2024.15.003

多重耐藥菌（multidrug-resistant organisms，MDRO）是指對可用的3類或3類以上抗菌藥物同時耐藥的病原菌［1］。近年來，日益突出的MDRO感染問題已成為一個重大的公共衛生問題，在全球范圍內引起了廣泛關注［2］。而重癥監護室（intensive care unit，ICU）的大多數病人由于病情嚴重且復雜多變、免疫功能低下，在治療過程中往往需要進行許多侵入性操作，更容易引發細菌感染，導致ICU感染率明顯高于普通病房［3］。MDRO感染增加了病人治療和用藥的難度，延長了病人的住院時間，增加了醫療費用及病死率［4］，給臨床進行抗感染治療帶來了嚴峻挑戰。世界衛生組織報道，歐洲、美國每年均有2萬～3萬人死于MDRO感染，造成了嚴重的經濟損失［5］。因此，本研究旨在分析ICU中MDRO感染的相關危險因素，落實MDRO防控及干預措施，以預防和減少ICU病人MDRO感染，節約醫療資源。……