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目的通过荟萃分析探讨国内多药耐药铜绿假单胞菌(MDRPA)感染的危险因素,为其感染预防与控制提供依据和借鉴。方法通过计算机检索中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库、维普数据库(VIP)以及PubMed等数据库,检索关于国内MDRPA感染危险因素的病例对照研究,检索时间均为建库至2015年6月,按纳入、排除标准由两人独立进行文献筛选、资料提取和质量评价后,采用RevMan5.0软件进行荟萃分析。结果纳入研究共6个,MDRPA感染患者345例,铜绿假单胞菌敏感菌株感染患者851例,荟萃分析结果显示,入住ICU/RCU、患有支气管扩张/慢性阻塞性肺疾病、混合感染、留置胃管、气管切开/插管、机械通气及感染前使用三、四代头孢菌素、喹诺酮类及碳青霉烯类抗菌药物、联用两类或两种抗菌药物、联用3类或3种抗菌药物等因素,MDRPA感染患者中比例明显高于PAE敏感患者;MDRPA感染患者感染前仅使用1类或1种抗菌药物的比例明显低于PAE敏感患者;MDRPA耐药性分析发现,耐药率最高的是庆大霉素和环丙沙星。结论 MDRPA感染与多个因素相关,临床医师应注意相关危险因素,合理使用抗菌药物,避免患者发生MDRPA感染。
Objective To explore the risk factors of multidrug-resistant Pseudomonas aeruginosa (MDRPA) infection in China through meta-analysis and provide references for prevention and control of infection. Methods A case-control study on the risk factors of MDRPA infection in China was searched by searching the databases of China Biomedical Literature Database (CBM), CNKI (China National Knowledge Infrastructure), Wanfang Database, VIP database and PubMed database According to the inclusion and exclusion criteria, the two databases were independently screened, data extracted and quality evaluated after the establishment of the database by June 2015. RevMan5.0 software was used for meta-analysis. Results A total of 6 studies were included in the study, 345 patients were infected with MDRPA and 851 patients were infected with Pseudomonas aeruginosa. According to meta-analysis, ICU / RCU patients with bronchiectasis / chronic obstructive pulmonary disease, mixed infection, Third, fourth generation cephalosporins, quinolones and carbapenem antibiotics, gastric cancer, tracheostomy / intubation, mechanical ventilation and infection before the use of two or two antibacterial drugs, combined with three types or 3 kinds of antibiotics and other factors, the proportion of patients with MDRPA infection was significantly higher than PAE-sensitive patients; MDRPA infection before infection with only 1 or 1 antimicrobial agents was significantly lower than the proportion of PAE-sensitive patients; MDRPA resistance analysis found that resistance The highest rates of gentamicin and ciprofloxacin. Conclusion MDRPA infection is related to many factors. Clinicians should pay attention to the relevant risk factors and use antimicrobial drugs rationally to avoid MDRPA infection.