产超广谱β内酰胺酶大肠埃希菌致尿路感染危险因素的Meta分析  

Meta-analysis of risk factors for urinary tract infection caused by ESBLs-producing Escherichia coli

作　　者：姜好 粟宏伟 罗小全 JIANG Hao;SU Hongwei;LUO Xiaoquan(Department of Urinary Surgery,the Traditional Chinese Medicine Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan,646000,China)

机构地区：[1]西南医科大学附属中医医院泌尿外科,四川泸州646000

出　　处：《当代医学》2023年第22期1-7,共7页Contemporary Medicine

基　　金：泸州市人民政府-西南医科大学科技战略合作项目(2017LZXNYD-T09);泸州市科技计划项目(2019-JYJ-67)。

摘　　要：目的评价产超广谱β内酰胺酶(ESBLs)大肠埃希菌所致尿路感染(UTI)的危险因素。方法检索中国期刊全文数据库(中国知网)、中国学术期刊数据库(万方)、中文科技期数据库(维普)、中国生物医学文献数据库及PubMed、Embase、WebofScience 2000年1月至2021年6月年发表的关于产ESBLs大肠埃希菌UTI的病例对照研究和队列研究。通过对文献筛选、质量评价、数据提取后采用Revman 5.3软件进行Meta分析。结果最终共纳入文献13篇,包含产ESBLs大肠埃希菌UTI患者1228例,非产ESBLs大肠埃希菌UTI患者4966例,从文献中提取与产ESBLs大肠埃希菌UTI相关的危险因素共21个。在21个危险因素中年龄≥65岁、住院史、入住ICU史、尿路感染史、反复尿路感染≥3次/年、手术史、泌尿外科手术史、留置尿管、肿瘤、激素使用史、免疫抑制剂使用史、抗生素使用史、使用头孢、使用三代头孢、使用氟喹诺酮、使用碳青霉烯的Meta分析结果差异有统计学意义(P<0.05),而患者性别、糖尿病、化疗史、使用青霉素类、二代头孢与产ESBLs大肠埃希菌UTI未见明显关联。对纳入文献数目≥10篇的危险因素运用RevMan的漏斗图评估发表偏倚,其中抗生素使用史漏斗图不对称存在发表偏倚。结论年龄≥65岁、住院史、入住ICU史、尿路感染史、反复尿路感染≥3次/年、手术史、泌尿外科手术史、留置尿管、肿瘤,激素使用史、免疫抑制剂使用史、抗生素使用史、使用头孢、使用三代头孢、使用氟喹诺酮、使用碳青霉烯是产ESBLs大肠埃希菌所致UTI的危险因素,医务人员应针对以上危险因素予以重点关注,采取必要措施以减少产ESBLs大肠埃希菌UTI的发生。Objective To evaluate the risk factors of urinary tract infection(UTI)caused by Escherichia coli producing Extended-spectrumβ-lac-tamase(ESBLs).Methods Case-control studies and cohort studies on ESBLS-producing Escherichia coli UTI published in China National Knowl-edge Infrastructure(CNKI),China Academic Journal Database(Wanfang),Chinese Science and Technology Journal Database(VIP),Chinese Bio-medical Literature Database,and published in PubMed,Embase,and Web of Science from January 2000 to June 2021 were searched.Revman 5.3 software was used for Meta-analysis after literature screening,quality evaluation and data extraction.Results A total of 13 papers were finally in-cluded in the literature,including 1228 patients with ESBLs-producing Escherichia coli UTI and 4966 patients with non-ESBLs-producing Esche-richia coli UTI.21 risk factors associated with ESBLs-producing Escherichia coli UTI were extracted from the literature.Among the 21 risk factors,there were statistically significant differences in the results of Meta-analysis of age≥65 years,history of hospitalization,history of ICU admission,history of urinary tract infection,recurrent urinary tract infection≥3 times/year,history of surgery,history of urological surgery,indwelling urinary catheter,tumor,history of hormone use,history of immunosuppressant use,history of antibiotic use,and the use of cephalosporins,use of third-gener-ation cephalosporins,use of fluoroquinolones,and use of carbapenems of the Meta-analysis results(P<0.05),and there was no significant correla-tion between ESBLS-producing EScherichia coli UTI with patient gender,diabetes mellitus,chemotherapy history,use of penicillins and second-gen-eration cephalosporin.Publication bias was assessed using RevMan's funnel plot for risk factors for the number of included literature≥10,where pub-lication bias existed in the asymmetry of the funnel plot for history of antibiotic use.Conclusion The results of meta-analysis showed that age≥65 years,history of hospitalization,history of admiss

关 键 词：尿路感染 产超广谱β内酰胺酶大肠埃希菌 危险因素 META分析 

分 类 号：R446.5[医药卫生—诊断学]