置管前尿道口消毒对导尿管相关尿路感染发生率的影响:Meta分析  

Effect of disinfection of urethral orifice before catheterization on the prevention of catheter-associated urinary tract infection:A Meta-analysis

作　　者：谢砚辞 聂奕轩 顾永华[1] 周桂芳[1] 李新芳[1] XIE Yan-ci;NIE Yi-xuan;GU Yong-hua;ZHOU Gui-fang;LI Xin-fang(Department of Infection Management, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215000, China;School of Medicine, Jiangsu University, Zhenjiang 212001, China)

机构地区：[1]南京医科大学附属苏州医院苏州市立医院感染管理处,江苏苏州215000 [2]江苏大学医学院,江苏镇江212001

出　　处：《中国感染控制杂志》2022年第6期592-599,共8页Chinese Journal of Infection Control

摘　　要：目的通过Meta分析探究留置导尿管前使用消毒剂消毒尿道口周围对预防导尿管相关尿路感染(CAUTI)的作用,以期为国内临床工作及CAUTI预防策略的制定提供参考。方法计算机检索万方、中国知网、中国生物医学文献库、PubMed、The Cochrane library、Web of Science、EMbase,搜集留置导尿管前消毒尿道口对CAUTI发病率影响的随机对照试验(RCT),检索的时间范围从建库到2021年8月。由两名研究者独立进行文献筛选,提取资料,对纳入文献进行偏倚风险评价,应用Stata 12.0软件进行Meta分析、敏感性分析、发表偏倚分析,应用GPower 3.1软件进行效能分析。结果共纳入7篇RCT,包括3030例导尿管置管患者。Meta分析结果显示:留置导尿管前尿道口消毒与清洁对CAUTI发病率的影响,差异无统计学意义(OR=0.78,95%CI:0.57~1.08,P=0.380),且无论极高人类发展指数国家(OR=0.75,95%CI:0.46~1.22,P=0.243)还是高人类发展指数国家(OR=0.91,95%CI:0.56~1.47,P=0.839),无论尿培养阳性判断标准是指菌落数>10^(5) CFU/mL(OR=0.71,95%CI:0.47~1.08,P=0.316)还是>10^(3) CFU/mL(OR=1.06,95%CI:0.58~1.91,P=0.642),留置导尿管前尿道口消毒与清洁对CAUTI发病率影响的差异均无统计学意义。结论系统评价与Meta分析结果表明,留置导尿管时对尿道口消毒与对尿道口清洁相比,预防CAUTI的效果无差异,与中国CAUTI预防相关指南要求不一致,但要制定符合中国国情的CAUTI预防标准,仍需更多在中国医疗环境下进行的高质量研究。Objective To explore the effect of disinfection of urethral orifice with antiseptic agent before catheteri-zation on the prevention of catheter-associated urinary tract infection(CAUTI)by Meta-analysis,provide reference for domestic clinical work and the formulation of CAUTI prevention strategy.Methods WanFang data,China national knowledge infrastructure(CNKI),China Biology Medicine disc(CBM),PubMed,The Cochrane library,Web of Science databases and EMbase were electronically retrieved to collect randomized controlled trials(RCTs)about the effect of urethral orifice disinfection before catheterization on the prevention of CAUTI,the retrieval time was from database establishment to August 2021.Two researchers independently screened the literatures,extracted data,evaluated the bias risk of the included literatures,Stata 12.0 software was adopted to conduct Meta-analysis,sensitivity analysis and publication bias analysis,GPower 3.1 software was used for efficacy analysis.Results A total of 7 RCTs were included,including 3030 patients with urinary catheterization.Meta-analysis showed that there was no significant difference in the incidence of CAUTI between disinfection and cleaning of urethral orifice before catheterization(OR=0.78,95%CI:0.57-1.08,P=0.380),whether the countries were with extremely high human development index(OR=0.75,95%CI:0.46-1.22,P=0.243)or high human development index(OR=0.91,95%CI:0.56-1.47,P=0.839),whether the positive criterion of urine culture was colony number>105 CFU/mL(OR=0.71,95%CI:0.47-1.08,P=0.316)or>103 CFU/mL(OR=1.06,95%CI:0.58-1.91,P=0.642),difference in the incidence of CAUTI between disinfection and cleaning of the urethral orifice before catheterization was not statistically significant.Conclusion Systematic evaluation and Meta-analysis results show that there is no difference in the efficacy of preventing CAUTI between disinfection and cleaning of urethral orifice before catheterization,which is inconsistent with the requirements of relevant guidelines for CAUTI prevention in Chi

关 键 词：导尿管相关尿路感染 尿道口消毒 尿道口清洁 META分析 

分 类 号：R181.32[医药卫生—流行病学]