A meta-analysis of status and risk factors of central venous catheter-associated bloodstream infection in ICU patients
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摘要:
目的 分析ICU患者导管相关性感染的危险因素。 方法 检索PubMed、Web of Science、Cochrane Library、CNKI、万方、CBM、EBSCO等数据库中有关ICU患者中心静脉导管相关性血流感染独立危险因素的相关文章,合并结局指标并使用RevMan 5.3软件进行meta分析。 结果 纳入13篇文献,共12 283例患者,出现感染的人数为773例,感染发生率为6.29%。危险因素共9项,包括导管留置时间≥7 d(OR=5.30,95% CI:3.39~8.27)、合并糖尿病(OR=21.15,95% CI:11.45~39.08)、置管前使用抗生素(OR=6.63,95% CI:5.12~8.58)、高龄(OR=3.01,95% CI:2.74~3.31)、穿刺次数>2次(OR=60.10,95% CI:30.63~117.94)、APACHEⅡ评分较高(OR=16.07,95% CI:8.97~28.77)、股静脉置管(OR=12.41,95% CI:3.82~40.30)、男性(OR=7.93,95% CI:3.69~17.04)、经历过急诊手术(OR=8.12,95% CI:3.43~19.19), 均P<0.05。 结论 导管留置时间≥7 d、患者合并糖尿病、置管前使用抗生素、患者年龄>55岁、置管次数>2次、APACHEⅡ评分较高、选择股静脉为留置部位、男性、经历过急诊手术是ICU患者发生中心导管相关性血流感染的主要危险因素。临床上应重视高危人群和相关危险因素,采取有效的干预措施,减少中心静脉导管相关性血流感染的发生。 Abstract:Objective To analyse the risk factors of catheter-related infection in ICU patients. Methods Related articles on independent risk factors of central venous catheter-related bloodstream infection in ICU patients were searched in PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, CBM, EBSCO and other databases. Outcomes were combined, and meta-analysis and sensitivity analysis were performed using RevMan 5.3 software. Results A total of 13 studies were included, including 12 283 patients and 773 infected patients. The infection rate was 6.29%. Nine risk factors were as follow: catheter indwelling days ≥7 days (OR=5.30, 95% CI: 3.39-8.27), diabetes mellitus (OR=21.15, 95% CI: 11.45-39.08), antibiotic use before catheterisation (OR=6.63, 95% CI: 5.12-8.58), advanced age (OR=3.01, 95% CI: 2.74-3.31), puncture frequency of >2 times (OR=60.10, 95% CI: 30.63-117.94), high APACHEⅡ score (OR=16.07, 95% CI: 8.97-28.77), femoral vein catheterisation (OR=12.41, 95% CI: 3.82-40.30), male (OR=7.93, 95% CI: 3.69-17.04), emergency surgery (OR=8.12, 95% CI: 3.43-19.19), all P < 0.05. Conclusions The main risk factors for central catheter-related bloodstream infection in ICU patients are catheter indwelling days ≥7 days, diabetes mellitus, antibiotics before catheterisation, age of > 55 years, catheterisation frequecy of >2 times, high APACHEⅡ score, femoral vein as the indwelling site, male and emergency surgery. Clinical attention should be paid to high-risk groups and related risk factors, and effective intervention measures should be taken to reduce the occurrence of central catheter-related bloodstream infection. -
Key words:
- ICU /
- Catheter-related bloodstream infection /
- Risk factors /
- Meta analysis
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表 1 13篇纳入文献基本特征及质量评价
Table 1. Basic characteristics and quality evaluation of 13 included literatures
序号 纳入文献 国家 感染例数 总例数 研究类型 危险因素 1 廖少玲[5]2016 中国 18 393 队列研究,回顾性分析 A、B 2 杨波[6]2016 中国 37 358 队列研究,回顾性分析 A、B、C、D 3 鲍珍[7]2020 中国 98 640 队列研究,回顾性分析 A、B、D、F、G 4 陶真[8]2017 中国 17 483 队列研究,回顾性分析 A、F 5 何清[9]2017 中国 31 610 队列研究,回顾性分析 A、C 6 张细江[10]2012 中国 60 623 队列研究 D、E、F 7 乔莉[11]2020 中国 28 674 队列研究,回顾性分析 A、F 8 WU S H[12]2017 中国 38 477 队列研究,回顾性分析 A、H、I 9 CHENG S Q[13]2019 中国 57 1 523 队列研究 A、B、E、G 10 LISSAUER M E[14]2012 韩国 58 746 队列研究,回顾性分析 B、C 11 HAJJEJ Z[15]2014 日本 32 260 前瞻性队列研究 B、F 12 ALONSO-ECHANOVE J[16]2003 美国 240 4 535 前瞻性队列研究 C、F 13 ESTEVE F[17]2011 美国 59 961 队列研究,回顾性分析 H、I 注:危险因素中A为导管留置时间;B为合并糖尿病;C为年龄;D为穿刺次数;E为留置部位;F为抗生素使用;G为APACHEⅡ评分(急性生理与慢性健康评估);H为男性;I为急诊手术。 表 2 纳入文献的质量评价(分)
Table 2. Quality evaluation of the included literatures (scores)
纳入研究 选择的研究人群 可比性 暴露 无应答率 NOS评分 病例恰当 代表性 对照选择 对照定义 病例 对照 暴露的确定 病例和对照的调查方法 张细江[10]2012 1 1 1 1 1 0 1 1 0 7 陶真[8]2017 1 1 1 1 0 1 1 1 0 7 廖少玲[5]2016 1 1 1 1 1 1 1 1 0 8 杨波[6]2016 1 1 1 1 1 0 1 0 1 7 何清[9]2017 1 1 1 1 1 0 1 1 0 7 鲍珍[7]2020 1 1 1 1 1 0 1 1 0 7 乔莉[11]2020 1 1 1 1 0 1 1 1 1 8 ALONSO-ECHANOVE J[16]2003 1 1 1 1 0 1 1 1 0 7 ESTEVE F[17]2011 1 1 1 1 0 1 1 0 1 7 HAJJEJ Z[15]2014 1 1 1 1 1 0 1 1 1 8 WU S H[12]2017 1 1 1 1 0 1 1 1 0 7 CHENG S Q[13]2019 1 1 1 1 1 0 1 0 0 6 LISSAUER M E[14]2012 1 1 1 1 1 1 1 1 1 9 表 3 ICU内CRBSI危险因素的meta分析结果
Table 3. Meta-analysis results of CRBSI risk factors in ICU
危险因素 文献数量 统计方法 合并OR值 95% CI P值 I2值(%) 导管留置时间≥7 d 8 固定效应模型 5.30 3.39,8.27 0.90 0 合并糖尿病 6 固定效应模型 21.15 11.45, 39.08 0.42 0 置管前使用抗生素 5 随机效应模型 6.63 5.12,8.58 <0.01 95 高龄 4 随机效应模型 3.01 2.74,3.31 <0.01 96 穿刺次数>2次 3 固定效应模型 60.10 30.63,117.94 0.35 5 APACHEⅡ评分较高 3 随机效应模型 16.07 8.97,28.77 0.02 76 股静脉置管 2 随机效应模型 12.41 3.82,40.30 0.08 68 男性 2 固定效应模型 7.93 3.69,17.04 0.58 0 经历过急诊手术 2 随机效应模型 8.12 3.43, 19.19 0.19 40 表 4 2种模型对ICU患者CRBSI危险因素的敏感性分析
Table 4. Sensitivity analysis of the two models to CRBSI risk factors in ICU patients
危险因素 随机效应模型合并
OR值(95% CI)固定效应模型合并
OR值(95% CI)患者合并糖尿病 21.15(11.45, 39.08) 21.15(11.45,39.08) 穿刺次数>2次 58.30(31.24, 108.82) 60.10(30.63,117.94) 男性 7.93(3.69,17.04) 7.93(3.69,17.04) -
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