1Center for Clinical Evidence Synthesis, Tufts Medical Center, 800 Washington Street, Box 63, Boston, MA 02111 USA.
2Merck & Co., Inc., Kenilworth, NJ USA.
Antimicrob Resist Infect Control. 2018 Jul 4;7:79. doi: 10.1186/s13756-018-0370-9. eCollection 2018.
Identifying risk factors predicting acquisition of resistant will aid surveillance and diagnostic initiatives and can be crucial in early and appropriate antibiotic therapy. We conducted a systematic review examining risk factors of acquisition of resistant among hospitalized patients.
MEDLINE®, EMBASE®, and Cochrane Central were searched between 2000 and 2016 for studies examining independent risk factors associated with acquisition of resistant , among hospitalized patients. Random effects model meta-analysis was conducted when at least three or more studies were sufficiently similar.
Of the 54 eligible articles, 28 publications (31studies) examined multi-drug resistant (MDR) or extensively drug resistant (XDR) and 26 publications (29 studies) examined resistant The acquisition of MDR , as compared with non-MDR , was significantly associated with intensive care unit (ICU) admission (3 studies: summary adjusted odds ratio [OR] 2.2) or use of quinolones (4 studies: summary adjusted OR 3.59). Acquisition of MDR or XDR compared with susceptible was significantly associated with prior hospital stay (4 studies: summary adjusted OR 1.90), use of quinolones (3 studies: summary adjusted OR 4.34), or use of carbapenems (3 studies: summary adjusted OR 13.68). The acquisition of MDR compared with non- was significantly associated with prior use of cephalosporins (3 studies: summary adjusted OR 3.96), quinolones (4 studies: summary adjusted OR 2.96), carbapenems (6 studies: summary adjusted OR 2.61), and prior hospital stay (4 studies: summary adjusted OR 1.74). The acquisition of carbapenem-resistant compared with susceptible , was statistically significantly associated with prior use of piperacillin-tazobactam (3 studies: summary adjusted OR 2.64), vancomycin (3 studies: summary adjusted OR 1.76), and carbapenems (7 studies: summary adjusted OR 4.36).
Prior use of antibiotics and prior hospital or ICU stay was the most significant risk factors for acquisition of resistant . These findings provide guidance in identifying patients that may be at an elevated risk for a resistant infection and emphasize the importance of antimicrobial stewardship and infection control in hospitals.
识别预测耐药菌获得的风险因素有助于监测和诊断计划，并且在早期和适当的抗生素治疗中至关重要。我们进行了一项系统评价，研究了住院患者获得耐药菌的风险因素。
2000 年至 2016 年期间，我们在 MEDLINE®、EMBASE®和 Cochrane Central 中搜索了研究住院患者获得耐药菌的独立风险因素的研究。当至少有三个或更多研究足够相似时，进行了随机效应模型荟萃分析。
在 54 篇合格的文章中，28 篇出版物（31 项研究）研究了多药耐药（MDR）或广泛耐药（XDR），26 篇出版物（29 项研究）研究了耐药菌。与非 MDR 相比，MDR 的获得与重症监护病房（ICU）入院（3 项研究：汇总调整后的优势比[OR]2.2）或使用喹诺酮类药物（4 项研究：汇总调整后的 OR 3.59）显著相关。与敏感菌相比，MDR 或 XDR 的获得与既往住院史（4 项研究：汇总调整后的 OR 1.90）、使用喹诺酮类药物（3 项研究：汇总调整后的 OR 4.34）或使用碳青霉烯类药物（3 项研究：汇总调整后的 OR 13.68）显著相关。与非 MDR 相比，MDR 的获得与头孢菌素（3 项研究：汇总调整后的 OR 3.96）、喹诺酮类药物（4 项研究：汇总调整后的 OR 2.96）、碳青霉烯类药物（6 项研究：汇总调整后的 OR 2.61）和既往住院史（4 项研究：汇总调整后的 OR 1.74）的使用显著相关。与敏感菌相比，耐碳青霉烯类药物的获得与哌拉西林他唑巴坦（3 项研究：汇总调整后的 OR 2.64）、万古霉素（3 项研究：汇总调整后的 OR 1.76）和碳青霉烯类药物（7 项研究：汇总调整后的 OR 4.36）的使用显著相关。
既往使用抗生素和既往住院或 ICU 住院是获得耐药菌的最重要危险因素。这些发现为识别可能处于耐药感染风险增加的患者提供了指导，并强调了医院内抗菌药物管理和感染控制的重要性。
