成人肠道CRE定植病例医院感染发病率的Meta分析  

Meta-analysis on the incidence of healthcare-associated infection in adult cases with intestinal carbapenem-resistant Enterobacterales colonization

作　　者：刘银梅[1] 王欣 杨惠英[1] 施菊妹 李颖川 LIU Yin-mei;WANG Xin;YANG Hui-ying;SHI Ju-mei;LI Ying-chuan(Department of Healthcare-associated Infection and Disease Control,Shanghai Tenth People’s Hospital,Shanghai 200072,China;Department of Hematology,Shanghai Dongfang Hospital,Shanghai 200120,China;Office of Hospital Director,Shanghai Tenth People’s Hospital,Shanghai 200072,China)

机构地区：[1]上海市第十人民医院院内感染与疾病控制处,上海200072 [2]上海市东方医院血液科,上海200120 [3]上海市第十人民医院院长办公室,上海200072

出　　处：《中国感染控制杂志》2024年第5期592-599,共8页Chinese Journal of Infection Control

基　　金：国家自然科学基金项目(82170200);上海申康医院发展中心管理研究项目(2023SKMR-04)。

摘　　要：目的系统评价成人肠道耐碳青霉烯类肠杆菌目细菌(CRE)定植病例医院感染发病率,为CRE医院感染的预防和控制提供参考依据。方法计算机检索Embase、Cochrane、PubMed、Web of Science、CNKI、万方、维普、中国生物医学文献数据库(CBM)8个数据库自建库至2023年6月CRE肠道定植病例医院感染发病率的相关文献,应用Stata 17.0软件进行Meta分析,采用敏感性分析评价研究结果的稳定性,采用Egger’s检验评价发表偏倚。结果共纳入16篇文献,其中英文11篇,中文5篇,总样本量2151例患者。Meta分析结果显示,成人肠道CRE定植病例医院感染发病率为23.1%(95%CI:14.8%~32.5%)。以不同研究设计类型、发表年份,以及研究调查的地域、科室和感染部位分组因素进行亚组分析,亚组间的合并效应量比较,差异均无统计学意义(均P>0.05)。在CRE定植发展为医院感染中,耐碳青霉烯类肺炎克雷伯菌(CRKP)占比96.0%(95%CI:86.8%~100%),定植病例中血流感染发病率为18.2%(95%CI:10.3%~27.6%)。CRE定植病例30天病死率为32.6%(95%CI:20.5%~45.9%),CRE感染病例30天病死率为36.9%(95%CI:16.0%~60.2%)。结论近年来CRE定植病例医院感染发病率较高,需对高危科室进行主动筛查和重点干预,以降低CRE定植病例医院感染发病率。Objective To systematically evaluate the incidence of healthcare-associated infection(HAI)in adult cases with carbapenem-resistant Enterobacterales(CRE)colonization in intestine,and provide referential basis for the prevention and control of HAI in cases colonized with CRE intestinally.Methods Literatures on the incidence of HAI in cases with intestinal CRE colonization were retrieved from 8 databases,including Embase,Cochrane,PubMed,Web of Science,CNKI,Wanfang,VIP,and China Biomedical Literature Database(CBM),dating back from the establishment of the databases to June 2023.Meta-analysis was conducted by Stata 17.0 software.Stability of the research results was evaluated by sensitivity analysis,and publication bias was evaluated by Egger’s test.Results A total of 16 articles were included in the study,with in total 2151 cases from 5 Chinese articles and 11 English articles.Meta-analysis results showed that the incidence of HAI in adult cases with intestinal CRE colonization was 23.1%(95%CI:14.8%-32.5%).Subgroup analysis was conducted based on grouping factors,such as different research design types,publication years,as well as research regions,departments,and infection sites.The differences in the combined effects among subgroups were not statistically significant(all P>0.05).Among the CRE developed from colonization to HAI,the proportion of carpabenem-resistant Klebsiella pneumoniae(CRKP)was 96.0%(95%CI:86.8%-100%),and the incidence of bloodstream infection in colonized cases was 18.2%(95%CI:10.3%-27.6%).The 30-day mortality of CRE colonized cases was 32.6%(95%CI:20.5%-45.9%),and the 30-day mortality of CRE infected cases was 36.9%(95%CI:16.0%-60.2%).Conclusion In recent years,the incidence of HAI in cases with CRE colonization is high,it is necessary to actively screen and focus on intervention in high-risk departments,so as to decrease the incidence of HAI in CRE colonized cases.

关 键 词：主动筛查 耐碳青霉烯类肠杆菌 耐药 肠杆菌目 定植 医院感染 META分析 

分 类 号：R181.32[医药卫生—流行病学]