Postgraduate Training for Applied Epidemiology, Robert Koch Institute, Germany; European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden; Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Postgraduate Training for Applied Epidemiology, Robert Koch Institute, Germany.
J Hosp Infect. 2018 Aug;99(4):367-380. doi: 10.1016/j.jhin.2018.03.017. Epub 2018 Mar 22.
At neonatal intensive care units, sepsis due to Gram-negative bacteria is an important cause of morbidity and mortality. The benefits of routine microbiological screening of neonatal body surface to predict and prevent sepsis are controversial.
To evaluate the prognostic value of neonatal body surface screening for colonization with Gram-negative bacteria for the prediction of late-onset sepsis.
A systematic review was performed, including studies of any design that reported data to calculate prognostic accuracy of surface screening for the prediction of late-onset sepsis. Risk of bias was assessed and a meta-analysis performed. Evidence quality was appraised using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology.
Eight studies (all cohort design) were identified as eligible. Studies were performed in six countries in Europe, Asia, and North America and comprised a total of 4829 participants. All studies were at high risk of bias. Pooled sensitivity of body surface screening to predict late-onset sepsis was 41% (95% confidence interval: 17-70), whereas pooled specificity was 56% (34-76) (hierarchical summary receiver operating characteristics (HSROC) model). Subgroup analyses showed higher pooled estimates for specificity but not sensitivity when screening focused on Escherichia coli or Klebsiella pneumoniae. GRADE evidence quality was very low.
Limited evidence of very low quality exists regarding the prognostic value of neonatal screening for late-onset sepsis. Carefully planned and conducted prospective studies, including randomized trials, are needed to clarify the potential value of this measure for the prediction and prevention of late-onset sepsis.
在新生儿重症监护病房，革兰氏阴性菌引起的败血症是发病率和死亡率的重要原因。对新生儿体表进行常规微生物筛查以预测和预防败血症的益处存在争议。
评估新生儿体表筛查革兰氏阴性菌定植对预测晚发性败血症的预后价值。
进行了系统评价，包括报告数据以计算表面筛查对预测晚发性败血症的预后准确性的任何设计的研究。评估了偏倚风险并进行了荟萃分析。使用 GRADE（推荐评估、制定与评估）方法评估证据质量。
确定了 8 项符合条件的研究（均为队列设计）。这些研究在欧洲、亚洲和北美六个国家进行，共纳入 4829 名参与者。所有研究均存在较高的偏倚风险。体表筛查预测晚发性败血症的汇总敏感性为 41%（95%置信区间：17-70），而汇总特异性为 56%（34-76）（分层汇总受试者工作特征（HSROC）模型）。亚组分析显示，当筛查重点关注大肠杆菌或肺炎克雷伯菌时，特异性的汇总估计值较高，但敏感性没有提高。GRADE 证据质量为极低。
关于新生儿筛查对晚发性败血症的预后价值的证据质量非常低。需要精心设计和进行前瞻性研究，包括随机试验，以阐明这种措施对预测和预防晚发性败血症的潜在价值。
