Epidemiological characteristics of hospital-acquired infections in pediatric patients supported by extracorporeal membrane oxygenation:A meta-analysis
王英 1钟博华 1王丽芳 2朗秋燕 1罗海彬 1王书林 1李春朋 3廖敏4
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作者信息
1. 广西医科大学第一附属医院重症一区,广西南宁 530021
2. 广西医科大学第一附属医院儿科重症监护室,广西南宁 530021
3. 河南省人民医院重症五区,河南郑州 450000
4. 广西中医药大学第一附属医院急诊科,广西南宁 530023
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摘要
目的 系统评价儿科体外膜肺氧合(ECMO)支持患者院内感染的流行病学特征.方法 采用主题词与自由词相结合的方式,系统检索中国知网、万方医学数据库、中国生物医学文献数据库、维普数据库、Pubmed、Embase、web of science数据库,搜集关于儿科ECMO支持患者院内感染的观察性研究,检索时限均为建库到2023年12月.由2名研究者独立进行文献筛选、提取资料、评价纳入研究的偏倚风险后,使用Stata 18.0软件进行meta分析.结果 共纳入16项研究,包括3 353例儿科ECMO支持患者,其中发生院内感染患者712例.随机效应模型meta分析结果显示,院内感染发生率为28.55％[95％CI(22.26％,35.28％)].病原学分布中以革兰阴性菌为主(约占68.68％),其中前3位为:鲍曼不动杆菌(26.93％)、肺炎克雷伯菌(11.90％)、铜绿假单胞菌(9.39％).结论 当前证据显示,儿科ECMO支持患者院内感染率较高,且可能受地域影响.受研究质量影响,上述结论尚待更高质量研究验证.
Abstract
Objective To systematically evaluate the epidemiological characteristics of nosocomial infections in pediatric patients supported by extracorporeal membrane oxygenation(ECMO).Methods A comprehensive search of observational studies related to nosocomial infections in pediatric ECMO patients published from database inception to December 2023 was conducted using a combination of subject terms and free words across multiple databases,including CNKI,Wanfang Medical Database,China Biomedical Literature Database,Weipu Database,Pubmed,Embase,and Web of Science.Two researchers independently screened the literatures,extracted data,and assessed the risk of bias in the included studies.Meta-analysis was performed using Stata 18.0 software.Results A total of 16 studies were included,encompassing 3,353 pediatric patients supported by ECMO,with 712 patients experiencing nosocomial infections.The random effects model in meta-analysis revealed that the overall incidence of nosocomial infections was 28.55％(95％CI[22.26％,35.28％]).The distribution of pathogens showed that Gram-negative bacteria were predominant(approximately 68.68％),with the top of Acinetobacter baumannii(26.93％),Klebsiella pneumoniae(11.90％),and Pseudo mon as aeruginosa(9.39％).Conclusion Current evidence indicates a high rate of nosocomial infections in pediatric patients supported by ECMO,potentially influenced by geographical factors.Due to the impact of study quality,these conclusions require verification through higher-quality research.
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