CAJ | 학술논문

目的系统评价中国综合性医院院内感染病原菌分布的变化趋势.方法计算机检索中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊全文数据库及万方数据知识服务平台,检索时间为建库至2013年3月,收集有关医院感染调查和研究的相关文献,由2名独立的研究者严格按照纳入和排除标准筛选文献、提取相关数据并采用Comprehensive Meta分析软件进行率的合并分析,将医院感染病原菌按照调查年份、医院等级、医院所在地区进行分层分析,根据异质性检验结果对医院院内感染不同病原菌分布率加权合并.结果共纳入345篇文献.合并结果显示:(1)1987-2000年真菌检出率为18.6％(95％CI:13.7％～ 24.9％)、葡萄球菌属为18.1％(95％CI:15.4％～ 21.0％)、假单胞菌属为14.8％(95％CI:12.2％～ 17.9％)、克雷伯菌属为5.2％(95％CI:4.1％～6.6％)；2001-2012年真菌检出率为17.6％(95％CI:16.4％～ 18.8％)、葡萄球菌属为15.0％(95％CI:14.2％～15.8％)、假单胞菌属为13.9％(95％CI:13.1％～14.7％)、克雷伯菌属为10.4％ (95％CI:9.9％～ 11.0％).(2)在二级及以下医院支原体检出率为3.2％(95％CI:0.3％～29.9％)、志贺菌属为4.7％(95％CI:3.4％～ 6.3％)、产碱杆菌属为7.2％ (95％CI:1.7％～ 26.1％)；三级医院支原体检出率为1.1％(95％CI:0.1％～15.4％)、志贺菌属为1.8％ (95％CI:0.6％～ 5.1％)、产碱杆菌属为4.3％(95％CI:2.3％～8.0％).(3)支原体检出率在长江流域经济区为14.3％ (95％CI:2.0％～ 58.1％)、西南经济区为0.3％(95％CI:0.1％～1.1％)；棒状杆菌属检出率在长江流域经济区为0.4％ (95％CI:0.1％～ 1.4％)、东南经济区为9.5％(95％CI:2.4％～ 31.1％)；嗜血杆菌属检出率在北方经济区为0.5％(95％CI:0.2％～ 0.9％)、东南经济区为9.2％(95％CI:7.3％～ 11.6％)；沙门菌属检出率在长江流域经济区为6.3％ (95％CI:4.6％～ 8.6％)、东南经济区为0.4％ (95％ CI:0.1％～3.0％).结论中国综合性医院院内感染最常见病原菌为真菌、葡萄球菌属、假单胞菌属；近年来克雷伯菌属检出率明显增多并成为最常见病原菌之一；在不同等级、不同地区医院院内感染病原菌分布率差异明显. 目的繫統評價中國綜閤性醫院院內感染病原菌分佈的變化趨勢.方法計算機檢索中國生物醫學文獻數據庫、中國期刊全文數據庫、維普中文科技期刊全文數據庫及萬方數據知識服務平檯,檢索時間為建庫至2013年3月,收集有關醫院感染調查和研究的相關文獻,由2名獨立的研究者嚴格按照納入和排除標準篩選文獻、提取相關數據併採用Comprehensive Meta分析軟件進行率的閤併分析,將醫院感染病原菌按照調查年份、醫院等級、醫院所在地區進行分層分析,根據異質性檢驗結果對醫院院內感染不同病原菌分佈率加權閤併.結果共納入345篇文獻.閤併結果顯示:(1)1987-2000年真菌檢齣率為18.6％(95％CI:13.7％～ 24.9％)、葡萄毬菌屬為18.1％(95％CI:15.4％～ 21.0％)、假單胞菌屬為14.8％(95％CI:12.2％～ 17.9％)、剋雷伯菌屬為5.2％(95％CI:4.1％～6.6％)；2001-2012年真菌檢齣率為17.6％(95％CI:16.4％～ 18.8％)、葡萄毬菌屬為15.0％(95％CI:14.2％～15.8％)、假單胞菌屬為13.9％(95％CI:13.1％～14.7％)、剋雷伯菌屬為10.4％ (95％CI:9.9％～ 11.0％).(2)在二級及以下醫院支原體檢齣率為3.2％(95％CI:0.3％～29.9％)、誌賀菌屬為4.7％(95％CI:3.4％～ 6.3％)、產堿桿菌屬為7.2％ (95％CI:1.7％～ 26.1％)；三級醫院支原體檢齣率為1.1％(95％CI:0.1％～15.4％)、誌賀菌屬為1.8％ (95％CI:0.6％～ 5.1％)、產堿桿菌屬為4.3％(95％CI:2.3％～8.0％).(3)支原體檢齣率在長江流域經濟區為14.3％ (95％CI:2.0％～ 58.1％)、西南經濟區為0.3％(95％CI:0.1％～1.1％)；棒狀桿菌屬檢齣率在長江流域經濟區為0.4％ (95％CI:0.1％～ 1.4％)、東南經濟區為9.5％(95％CI:2.4％～ 31.1％)；嗜血桿菌屬檢齣率在北方經濟區為0.5％(95％CI:0.2％～ 0.9％)、東南經濟區為9.2％(95％CI:7.3％～ 11.6％)；沙門菌屬檢齣率在長江流域經濟區為6.3％ (95％CI:4.6％～ 8.6％)、東南經濟區為0.4％ (95％ CI:0.1％～3.0％).結論中國綜閤性醫院院內感染最常見病原菌為真菌、葡萄毬菌屬、假單胞菌屬；近年來剋雷伯菌屬檢齣率明顯增多併成為最常見病原菌之一；在不同等級、不同地區醫院院內感染病原菌分佈率差異明顯.
목적 계통평개중국종합성의원원내감염병원균분포적변화추세.방법 계산궤검색중국생물의학문헌수거고、중국기간전문수거고、유보중문과기기간전문수거고급만방수거지식복무평태,검색시간위건고지2013년3월,수집유관의원감염조사화연구적상관문헌,유2명독립적연구자엄격안조납입화배제표준사선문헌、제취상관수거병채용Comprehensive Meta분석연건진행솔적합병분석,장의원감염병원균안조조사년빈、의원등급、의원소재지구진행분층분석,근거이질성검험결과대의원원내감염불동병원균분포솔가권합병.결과 공납입345편문헌.합병결과현시:(1)1987-2000년진균검출솔위18.6％(95％CI:13.7％～ 24.9％)、포도구균속위18.1％(95％CI:15.4％～ 21.0％)、가단포균속위14.8％(95％CI:12.2％～ 17.9％)、극뢰백균속위5.2％(95％CI:4.1％～6.6％)；2001-2012년진균검출솔위17.6％(95％CI:16.4％～ 18.8％)、포도구균속위15.0％(95％CI:14.2％～15.8％)、가단포균속위13.9％(95％CI:13.1％～14.7％)、극뢰백균속위10.4％ (95％CI:9.9％～ 11.0％).(2)재이급급이하의원지원체검출솔위3.2％(95％CI:0.3％～29.9％)、지하균속위4.7％(95％CI:3.4％～ 6.3％)、산감간균속위7.2％ (95％CI:1.7％～ 26.1％)；삼급의원지원체검출솔위1.1％(95％CI:0.1％～15.4％)、지하균속위1.8％ (95％CI:0.6％～ 5.1％)、산감간균속위4.3％(95％CI:2.3％～8.0％).(3)지원체검출솔재장강류역경제구위14.3％ (95％CI:2.0％～ 58.1％)、서남경제구위0.3％(95％CI:0.1％～1.1％)；봉상간균속검출솔재장강류역경제구위0.4％ (95％CI:0.1％～ 1.4％)、동남경제구위9.5％(95％CI:2.4％～ 31.1％)；기혈간균속검출솔재북방경제구위0.5％(95％CI:0.2％～ 0.9％)、동남경제구위9.2％(95％CI:7.3％～ 11.6％)；사문균속검출솔재장강류역경제구위6.3％ (95％CI:4.6％～ 8.6％)、동남경제구위0.4％ (95％ CI:0.1％～3.0％).결론 중국종합성의원원내감염최상견병원균위진균、포도구균속、가단포균속；근년래극뢰백균속검출솔명현증다병성위최상견병원균지일；재불동등급、불동지구의원원내감염병원균분포솔차이명현.
Objective To provide basic and direction for nosocomial infection prevention and control through evaluation the distribution of nosocomial infection pathogens and understand current situation of pathogens among general hospital in China.Methods Articles were searched and collected from CBM,CNKI,VIP database and Wanfang database published between creating database to March.2013 about investigation of nosocomial infection.Those literatures were screened and extracted according to the inclusion and exclusion criteria by two reviewers independently.The analysis of pathogens distribution was performed by using comprehensive Meta analysis software and stratified by factor as year,hospital level and region of the study.The distribution rate of different pathogens were merged according to statistical tests for the heterogeneity test.Results The 345 trials were included.The results show 1) the pooled distribution rates of common pathogens in 1987-2000 were as follows:18.6％ (95％CI:13.7％-24.9％),18.1％ (95％CI:15.4％-21.0％),14.8％ (95％CI:12.2％-17.9％),5.2％ (95％ CI:4.1％-6.6％) for Fungus,Staphylococcus,Pseudomonas,and Klebsiella respectively; the pooled rates of common pathogens in 2001-2012 were as follows:17.6％ (95％ CI:16.4％-18.8％),15.0％ (95％CI:14.2％-15.8％),13.9％ (95％CI:13.1％-14.7％),10.4％ (95％ CI:9.9％-11.0％) for Fungus,Staphylococcus,Pseudomonas,and Klebsiella respectively.2) The pooled distribution rates of pathogens in second and below grade hospital were 3.2％ (95％CI:0.3％-29.9％),4.7％ (95％ CI:3.4％-6.3％),7.2％ (95％ CI:1.7％-26.1％) for Mycoplasma,Shigella and Alkaligenes respectively; the pooled distribution rates of pathogens in third grade hospital were 1.1％ (95％CI:0.1％-15.4％),1.8％ (95％ CI:0.6％-5.1％),4.3％ (95％ CI:2.3％-8.0％) for Mycoplasma,Shigella and Alkaligenes respectively.3) The pooled rate of Mycoplasma for Yangtze River Economic Area was 14.3％ (95％CI:2.0％-58.1％) and for Southwest Economic Area was 0.3％ (95％CI:0.1％-1.1％).The pooled rate of Corynebacterium for Yangtze River Economic Area was 0.4％ (95 ％ CI:0.1％-1.4％) and for Southeast Economic Area was 9.5％ (95％CI:2.4％-31.1％).The pooled rate of Haemophilus for Northern Economic Area was 0.5％ (95％CI:0.2％-0.9％) and for Southeast Economic Area was 9.2％ (95％ CI:7.3％-11.6％).The pooled rate of Salmonella for Yangtze River Economic Area was 6.3％ (95％ CI:4.6％-8.6％) and for Southeast Economic Area was 0.4％ (95％ CI:0.1％-3.0％).Conclusion The common nosocomial infection pathogens were Fungus,Staphylococcus,Pseudomonas and Escherichia among general hospitals in China.A remarkable note is that Klebsiella was increased significantly in recent years and becomes one of the most common pathogens.There were differences in the distribution rate of nosocomial infection pathogens among general hospitals between levels and regions in China.