Vickers Mark L, Malacova Eva, Milinovich Gabriel J, Harris Patrick, Eriksson Lars, Dulhunty Joel M, Cotta Menino O
Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
ANZ J Surg. 2019 Oct;89(10):1256-1260. doi: 10.1111/ans.15393. Epub 2019 Sep 3.
We conducted a systematic review and meta-analysis to identify potentially modifiable risk factors for multidrug-resistant Gram-negative colonization or infection in critically ill burn patients.
A systematic search was conducted of PubMed, Embase, CINAHL, Web of Science and Central (Cochrane). Risk factors including antibiotic use and hospital interventions were summarized in a random-effects meta-analysis. Risk of publication bias was assessed using the Grading of Recommendations Assessment, Development and Evaluation method and funnel plots.
A total of 11 studies met the inclusion criteria. We identified several potentially modifiable risk factors and were able to grade their importance based on effect size. Related to prior antibiotic exposure, extended-spectrum cephalosporins (pooled odds ratio (OR) 7.00, 95% confidence interval (CI) 2.77-17.67), carbapenems (pooled OR 6.65, 95% CI 3.49-12.69), anti-pseudomonal penicillins (pooled OR 4.23, 95% CI 1.23-14.61) and aminoglycosides (pooled OR 4.20, 95% CI 2.10-8.39) were most significant. Related to hospital intervention, urinary catheters (pooled OR 11.76, 95% CI 5.03-27.51), arterial catheters (pooled OR 8.99, 95% CI 3.84-21.04), mechanical ventilation (pooled OR 5.49, 95% CI 2.59-11.63), central venous catheters (pooled OR 4.26, 95% CI 1.03-17.59), transfusion or blood product administration (pooled OR 4.19, 95% CI 1.48-11.89) and hydrotherapy (pooled OR 3.29, 95% CI 1.64-6.63) were most significant.
Prior exposure to extended-spectrum cephalosporins and carbapenems, as well as the use of urinary catheters and arterial catheters pose the greatest threat for infection or colonization with multidrug-resistant Gram-negative organisms in the critically ill burn patient population.
我们进行了一项系统评价和荟萃分析，以确定重症烧伤患者多重耐药革兰阴性菌定植或感染的潜在可改变风险因素。
对PubMed、Embase、CINAHL、Web of Science和CENTRAL（Cochrane）进行系统检索。在随机效应荟萃分析中总结了包括抗生素使用和医院干预在内的风险因素。使用推荐分级评估、制定和评价方法及漏斗图评估发表偏倚风险。
共有11项研究符合纳入标准。我们确定了几个潜在的可改变风险因素，并能够根据效应大小对其重要性进行分级。与既往抗生素暴露相关，广谱头孢菌素（合并比值比（OR）7.00，95%置信区间（CI）2.77-17.67）、碳青霉烯类（合并OR 6.65，95%CI 3.49-12.69）、抗假单胞菌青霉素（合并OR 4.23，95%CI 1.23-14.61）和氨基糖苷类（合并OR 4.20，95%CI 2.10-8.39）最为显著。与医院干预相关，导尿管（合并OR 11.76，95%CI 5.03-27.51）、动脉导管（合并OR 8.99，95%CI 3.84-21.04）、机械通气（合并OR 5.49，95%CI 2.59-11.63）、中心静脉导管（合并OR 4.26，95%CI 1.03-17.59）、输血或血液制品输注（合并OR 4.19，95%CI 1.48-11.89）和水疗（合并OR 3.29，95%CI 1.64-6.63）最为显著。
既往暴露于广谱头孢菌素和碳青霉烯类，以及使用导尿管和动脉导管对重症烧伤患者群体感染或定植多重耐药革兰阴性菌构成最大威胁。
