我国医疗机构院内碳青霉烯类耐药菌预防与控制策略的Meta分析
Prevention and control strategies for carbapenem-resistant organism in medical institutions in China:a meta-analysis
郭琳雯 1黄文治 1曾妮 2乔甫1
作者信息
- 1. 四川大学华西医院感染性疾病中心(成都 610041);四川大学华西医院医院感染管理部(成都 610041)
- 2. 贵州医科大学附属医院医院感染管理科(贵阳 561113)
- 折叠
摘要
目的 采用Meta分析方法,评价我国医疗机构院内碳青霉烯类耐药菌(carbapenem-resistant organism,CRO)预防与控制策略.方法 检索 PubMed、Embase、Medline(Ovid)、Web of Science、中国知网、维普中文科技期刊数据库和万方数据库7个数据库,收集发表时间为建库至2023年的关于CRO预防和控制的我国医疗机构研究进行Meta分析.结果 共纳入21篇文献,3篇随机对照研究,18篇非随机对照研究.Meta分析结果显示,与标准防控措施相比,强化干预措施(包括主动筛查、信息化透明监管模式、综合干预和集束化防控策略可有效降低 CRO 感染率[相对危险度(relative risk,RR)=0.40,95％置信区间(confidence interval,CI)(0.25,0.65),P＜0.05].开展院内主动筛查能有效降低CRO感染率[RR=0.52,95％CI(0.30,0.91),P＜0.05]和碳青霉烯类耐药肠杆菌(carbapenem-resistant Enterobacteriaceae,CRE)感染率[RR=0.47,95％CI(0.24,0.93),P＜0.05].信息化透明监管可通过提高标准防控措施的依从性,而降低CRE感染率[RR=0.42,95％CI(0.28,0.62),P＜0.05].结论 与标准防控措施相比,强化干预措施能有效降低CRO院内传播和感染风险,在临床实践中可将集束化综合干预与信息化透明监管相结合,必要时开展高危人群CRO主动筛查.
Abstract
Objective To evaluate the efficiency of prevention and control strategies of carbapenem-resistant organism(CRO)in medical institutions in China using meta-analysis method.Methods PubMed,Embase,Medline(Ovid),Web of Science,China National Knowledge Infrastructure,Chongqing VIP and Wanfang Database were systematically searched for studies on CRO prevention and control in Chinese medical institutions from the establishment of databases to 2023 for meta-analysis.Results A total of 21 studies were included,consisting of 3 randomized controlled studies and 18 non-randomized controlled studies.The meta-analysis results showed that compared with standard prevention and control measures,strengthened intervention measures(including active screening,information-based transparent supervision mode,comprehensive intervention,and bundled prevention and control strategies)could effectively reduce the CRO infection rate[relative risk(RR)=0.40,95％confidence interval(CI)(0.25,0.65),P＜0.05].Proactive screening could effectively reduce the CRO infection rate[RR=0.52,95％CI(0.30,0.91),P＜0.05]and carbapenem-resistant Enterobacteriaceae(CRE)infection rate[RR=0.47,95％CI(0.24,0.93),P＜0.05].Information-based transparent supervision could reduce the CRE infection rate by improving compliance with standard prevention and control measures[RR=0.42,95％CI(0.28,0.62),P＜0.05].Conclusions Compared with standard prevention and control measures,strengthened intervention measures can effectively reduce the risk of in-hospital transmission and infection of CRO.In clinical practice,bundled comprehensive intervention can be combined with information-based transparent supervision,and if necessary,proactive screening of CRO in high-risk populations should be carried out.
关键词
碳青霉烯类耐药菌/预防/控制/Meta分析Key words
Carbapenem-resistant organism/prevention/control/meta-analysis引用本文复制引用
基金项目
国家卫生健康委卫生发展研究中心研究课题(2020-53)
出版年
2024
NETL
NSTL
万方数据