感染碳青霉烯耐药的肠杆菌科细菌患者全因死亡的Meta分析

目的:评价耐碳青霉烯肠杆菌科细菌感染患者全因死亡风险?方法:检索Pubmed数据库?Embase数据库,并辅以文献追溯?手工检索,检索时间为2001年1月1日至2015年12月31日?纳入同时含有碳青霉烯耐药肠杆科细菌(CRE)及碳青霉烯敏感的肠杆菌细菌(CSE)的临床特征及预后的研究?采用Stata14.0软件进行文献数据进行分析,并评价Meta分析结果的稳定性和发表偏倚?结果:16项研究符合纳入标准,包括2 916例患者(CRE感染797例,CSE 2 119例)?根据纳入研究的设计类型分为队列研究?病例对照研究;根据感染患者细菌检出的标本类型分为血流感染组亚组?综合感染类型亚组(包括尿液?血液?痰等)?队列研究组的CRE感染全因死亡的相对危险度(risk ratio,RR)为2.44(95%CI:1.96~3.03,I2=16.1%,Pheterogeneity=0.312);血流感染亚组的RR为2.07(95%CI:1.59~2.69,I2=0.0%,Pheterogeneity=0.511);综合感染类型亚组的RR为3.35(95%CI:2.25~4.99,I2=0.0%,Pheterogeneity=0.868)?病例对照组的比值比(odds ratio,OR)为2.30(95%CI:1.49~3.55,I2=53.5%,Pheterogeneity=0.018);血流感染亚组的OR为2.85(95%CI:1.66~4.90,I2=60.8%,Pheterogeneity=0.018);综合感染类型亚组的OR为1.46(95%CI:0.73~2.90,I2=25.2%,Pheterogeneity=0.261)?结论:CRE患者病死率明显高于CSE患者,血流感染与患者死亡是密切相关的?

All-cause deaths attributable to carbapenem-resistant enterobacteriaceae infection

Objective:To estimate the risk of deaths attributable to carbapenem-resistant enterobacteriaceae by performing a systematic review and meta-analysis. Methods:The Embase and PubMed databases were searched from January 1,2001 to December 31,2015 to identify eligible cohort studies. The initial literatures and references listed in the literature were manually searched. Controlled studies were analyzed using stata14.0 software. The risk ratio(RR)was pooled and the publication bias was evaluated using funnel plots. Results:Sixteen studies with a total of 2 916 patients were included for systematic review(the number of patients with carbapenem-resistant infections were 797 and those with carbapenem-susceptible infections were 2 119). According to the type of design,studies were divided into cohort studies and case control studies. According to the infection of specimen type,studies were divided into bloodstream infection type subgroup and comprehensive infection type subgroup. The risk ratio of the mortality in cohort studies was 2.44(95%CI:1.96~3.03,I2=16.1%,Pheterogeneity=0.312);the risk ratio of bloodstream infection was 2.07(95%CI:1.59~2.69,I2=0.0%,Pheterogeneity=0.511);the risk ratio of comprehensive infection type subgroups was 3.35(95%CI:2.25~4.99,I2=0.0%,Pheterogeneity=0.868). The rodds ratio of the mortality in case control studies was 2.30(95%CI:1.49~3.55,I2=53.5%,Pheterogeneity=0.018). The rodds ratio of bloodstream infection was 2.85(95%CI:1.66~4.90,I2=60.8%,Pheterogeneity=0.018). The rodds ratio of Comprehensive infection type subgroups was 1.46(95%CI:0.73~2.90,I2=25.2%,Pheterogeneity=0.261). Conclusion:Pooled outcomes showed that the number of deaths was significantly higher in patients with carbapenem-resistant infections and that the number of deaths attributable to carbapenem resistance is considerable,carbapenem resistant enterobacteriaceae in the bloodstream infections is closely related to death of patients.