亚洲成人呼吸机相关性肺炎的系统评价和荟萃分析：按国民收入水平分析发病率和病因。
A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology.
机构信息
Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam.
University of Miami Miller School of Medicine, Florida.
出版信息
Clin Infect Dis. 2019 Jan 18;68(3):511-518. doi: 10.1093/cid/ciy543.
BACKGROUND
Ventilator-associated pneumonia (VAP) is the commonest hospital-acquired infection (HAI) in intensive care. In Asia, VAP is increasingly caused by resistant gram-negative organisms. Despite the global antimicrobial resistance crisis, the epidemiology of VAP is poorly documented in Asia.
METHODS
We systematically reviewed literature published on Ovid Medline, Embase Classic, and Embase from 1 January 1990 to 17 August 2017 to estimate incidence, prevalence, and etiology of VAP. We performed a meta-analysis to give pooled rates and rates by country income level.
RESULTS
Pooled incidence density of VAP was high in lower- and upper-middle-income countries and lower in high-income countries (18.5, 15.2, and 9.0 per 1000 ventilator-days, respectively). Acinetobacter baumannii (n = 3687 [26%]) and Pseudomonas aeruginosa (n = 3176 [22%]) were leading causes of VAP; Staphylococcus aureus caused 14% (n = 1999). Carbapenem resistance was common (57.1%).
CONCLUSIONS
VAP remains a common cause of HAI, especially in low- and middle-income countries, and antibiotic resistance is high.
背景
呼吸机相关性肺炎（VAP）是重症监护病房中最常见的医院获得性感染（HAI）。在亚洲，VAP 越来越多地由耐药革兰氏阴性菌引起。尽管存在全球抗菌药物耐药性危机，但亚洲的 VAP 流行病学情况记录不佳。
方法
我们系统地检索了 1990 年 1 月 1 日至 2017 年 8 月 17 日在 Ovid Medline、Embase Classic 和 Embase 上发表的文献，以估计 VAP 的发病率、患病率和病因。我们进行了荟萃分析，以给出汇总率和按国家收入水平的比率。
结果
中低收入国家和高收入国家的 VAP 累积发病率密度较高（分别为 18.5、15.2 和 9.0 例/1000 机械通气日）。鲍曼不动杆菌（n = 3687 [26%]）和铜绿假单胞菌（n = 3176 [22%]）是 VAP 的主要病原体；金黄色葡萄球菌引起的 VAP 占 14%（n = 1999）。碳青霉烯类耐药很常见（57.1%）。
结论
VAP 仍然是 HAI 的常见原因，特别是在中低收入国家，且抗生素耐药性很高。
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