基于莫匹罗星的靶向性和普遍性去定植在预防心胸外科手术患者手术部位感染中的作用：一项系统评价和荟萃分析。
Role of targeted and universal mupirocin-based decolonization for preventing surgical-site infections in patients undergoing cardiothoracic surgery: A systematic review and meta-analysis.
作者信息
Wang Li, Ji Qi, Hu Xiaoyan
机构信息
Departments of Operating Room, The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu 222002, P.R. China.
Departments of Tongguan Operating Room, The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu 222002, P.R. China.
出版信息
Exp Ther Med. 2021 May;21(5):416. doi: 10.3892/etm.2021.9860. Epub 2021 Feb 25.
The purpose of the present study was to provide a systematic literature review and pool evidence on the efficacy of mupirocin-based decolonization protocol in reducing surgical-site infections (SSIs) in patients undergoing cardiothoracic (CT) surgery based on their (.) carrier state. The PubMed, Embase, Ovid, BioMed Central, Cochrane Central Register of Controlled Trials and Google Scholar databases were searched for studies comparing mupirocin-based decolonization with controls for reducing SSIs in patients following CT surgery. Studies were grouped based on the targeted population of intervention, i.e. carriers or all patients. A total of 17 studies were included. Of these, 8 studies used targeted mupirocin-based decolonization, while universal decolonization was performed in 9 studies. The results were conflicting for studies performing targeted decolonization and it was not possible to perform a meta-analysis due to non-homogenous studies. Pooled analysis of 34,859 patients indicated that universal mupirocin-based decolonization significantly reduced the risk of all SSIs [risk ratio (RR): 0.54; 95% CI: 0.40,0.75; I=73.35%]. The intervention significantly reduced the risk of superficial SSIs (RR: 0.37; 95% CI: 0.25,0.55; I=0%) but not of deep SSIs (RR: 0.45; 95% CI: 0.19,1.09; I=80.67%). The results indicated a significantly reduced risk of SSIs (SA-SSIs) with mupirocin-based decolonization (RR: 0.44; 95% CI: 0.32,0.61; I=0%) but not for methicillin-resistant (MRSA-SSIs; RR: 0.25; 95% CI: 0.05,1.28; I=79.07%). Evidence on the role of targeted mupirocin-based decolonization to reduce SSIs after CT surgery was non-coherent and inconclusive. Analysis of low-quality retrospective studies suggested that universal mupirocin-based decolonization may reduce all SSIs, superficial SSIs and SA-SSIs, but not deep SSIs or MRSA-SSIs in patients after CT surgery.
本研究的目的是基于患者的（.）携带状态，对以莫匹罗星为基础的去定植方案在降低心胸外科（CT）手术患者手术部位感染（SSI）方面的疗效进行系统的文献综述并汇总证据。检索了PubMed、Embase、Ovid、BioMed Central、Cochrane对照试验中心注册库和谷歌学术数据库，以查找比较以莫匹罗星为基础的去定植与对照组在降低CT手术后患者SSI方面的研究。研究根据干预的目标人群进行分组，即携带者或所有患者。总共纳入了17项研究。其中，8项研究采用了针对性的以莫匹罗星为基础的去定植，而9项研究进行了普遍去定植。针对进行针对性去定植的研究，结果存在冲突，由于研究的异质性，无法进行荟萃分析。对34,859名患者的汇总分析表明，普遍的以莫匹罗星为基础的去定植显著降低了所有SSI的风险[风险比（RR）：0.54；95%置信区间：0.40,0.75；I² = 73.35%]。该干预措施显著降低了浅表SSI的风险（RR：0.37；95%置信区间：0.25,0.55；I² = 0%），但未降低深部SSI的风险（RR：0.45；95%置信区间：0.19,1.09；I² = 80.67%）。结果表明，以莫匹罗星为基础的去定植显著降低了手术部位浅表感染（SA-SSI）的风险（RR：0.44；95%置信区间：0.32,0.61；I² = 0%），但对耐甲氧西林金黄色葡萄球菌引起的手术部位感染（MRSA-SSI）没有效果（RR：0.25；95%置信区间：0.05,1.28；I² = 79.07%）。关于针对性的以莫匹罗星为基础的去定植在降低CT手术后SSI方面作用的证据不一致且尚无定论。对低质量回顾性研究的分析表明，普遍的以莫匹罗星为基础的去定植可能会降低CT手术后患者的所有SSI、浅表SSI和SA-SSI，但不会降低深部SSI或MRSA-SSI。
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