儿童重症监护室患儿多重耐药菌感染影响因素的Meta分析  

Influencing factors of multi drug resistant organisms infection of children in pediatric intensive care unit:a Meta analysis

作　　者：王琪[1,2] 张霞[1,2] 雷蕾[1,2] 徐敏[1,2] 张帅 杨金蓉[1,2] WANG Qi;ZHANG Xia;LEI Lei;XU Min;ZHANG Shuai;YANG Jinrong(West China Second University Hospital,Sichuan University/West China School of Nursing,Sichuan University,Sichuan 610041 China)

机构地区：[1]四川大学华西第二医院/四川大学华西护理学院,四川610041 [2]出生缺陷与相关妇儿疾病教育部重点实验室

出　　处：《护理研究》2021年第18期3210-3217,共8页Chinese Nursing Research

摘　　要：目的:系统评价儿童重症监护室(PICU)患儿多重耐药菌(MDRO)感染的影响因素。方法:检索PubMed、EMbase、The Cochrane Library、Web of Science、中国知网(CNKI)、万方数据库(Wanfang Data)、中文科技期刊数据库(VIP)等数据库从建库至2020年11月19日收录的PICU患儿MDRO感染影响因素研究相关文献,2名研究员独立完成文献筛选、数据提取和质量评价后,采用RevMan 5.3软件进行Meta分析。结果:纳入20篇文献。Meta分析结果显示:留置经锁骨下穿刺中心静脉置管[OR=4.55,95%CI(2.89,7.16),P<0.01]、经锁骨下穿刺中心静脉置管留置>7 d[OR=11.82,95%CI(2.64,52.86),P<0.01]、机械通气[OR=3.30,95%CI(2.04,5.35),P<0.01]、机械通气>7 d[OR=17.75,95%CI(5.90,53.40),P<0.01]、留置尿管[OR=1.88,95%CI(1.05,3.37),P=0.03]、肠外营养[OR=4.80,95%CI(1.59,14.52),P<0.01]、PICU住院时间[WMD=1.23,95%CI(0.36,2.10),P<0.01]、住院史[OR=1.74,95%CI(1.04,2.91),P=0.04]、输血史[OR=2.98,95%CI(1.86,4.78),P<0.01]、发生2种以上并发症[OR=5.25,95%CI(2.65,10.43),P<0.01]、不合理使用抗生素[OR=4.49,95%CI(2.61,7.75),P<0.01]、之前使用过抗生素[OR=7.66,95%CI(3.13,18.75),P<0.01]、使用3种以上抗生素[OR=2.39,95%CI(1.47,3.88),P<0.01]、使用碳青霉烯类抗生素[OR=2.63,95%CI(1.64,4.21),P<0.01]、使用氨基糖苷类抗生素[OR=2.26,95%CI(1.28,4.00),P<0.01]、使用糖肽类抗生素[OR=8.24,95%CI(3.91,17.38),P<0.01]是PICU患儿MDRO感染的影响因素。结论:现有证据表明,PICU是MDRO感染的高风险区域,应依据其相关危险因素采取预防与控制措施,减少多重耐药菌感染的发生。Objective:To systematically evaluate the influencing factors of multi drug resistant organisms(MDRO)infection of children in pediatric intensive care unit(PICU).Methods:Articles on influencing factors of multi drug resistant organisms infection of children in pediatric intensive care unit,were retrieved from PubMed,EMbase,The Cochrane Library,Web of Science,CNKI,Wanfang Data,and VIP.The retrieval period was from the establishment of databases to 19 November,2020.After two researchers independently completed literature screening,data extraction and quality evaluation,RevMan 5.3 software was used for Meta analysis.Results:A total of 20 articles were included.Meta analysis results showed that indwelling central venous catheter through subclavian puncture[OR=4.55,95%CI(2.89,7.16),P<0.01],indwelling central venous catheter>7 d[OR=11.82,95%CI(2.64,52.86),P<0.01],mechanical ventilation[OR=3.30,95%CI(2.04,5.35),P<0.01],mechanical ventilation>7 d[OR=17.75,95%CI(5.90,53.40),P<0.01],indwelling catheter[OR=1.88,95%CI(1.05,3.37),P=0.03],parenteral nutrition[OR=4.80,95%CI(1.59,14.52),P<0.01],PICU hospitalization time[WMD=1.23,95%CI(0.36,2.10),P<0.01],hospitalization history[OR=1.74,95%CI(1.04,2.91),P=0.04],blood transfusion history[OR=2.98,95%CI(1.86,4.78),P<0.01],occurrence of more than 2 complications[OR=5.25,95%CI(2.65,10.43),P<0.01],irrational use of antibiotics[OR=4.49,95%CI(2.61,7.75),P<0.01],using antibiotics once[OR=7.66,95%CI(3.13,18.75),P<0.01],using more than 3 antibiotics[OR=2.39,95%CI(1.47,3.88),P<0.01],using carbapenem antibiotics[OR=2.63,95%CI(1.64,4.21),P<0.01],using aminoglycoside antibiotics[OR=2.26,95%CI(1.28,4.00),P<0.01],using of glycopeptide antibiotics[OR=8.24,95%CI(3.91,17.38),P<0.01]were influencing factors of MDRO infection in PICU children.Conclusions:Current evidence shows that PICU is a high⁃risk area for MDRO infection.Prevention and control measures should be taken based on the related risk factors to reduce occurrence of MDRO infection.

关 键 词：重症监护 患儿 多重耐药菌 影响因素 META分析 循证护理 

分 类 号：R720.597[医药卫生—急诊医学] R446.5[医药卫生—儿科]