CAJ | 학술논문

目的：通过荟萃分析与系统评价现有ICU医院感染目标性监测方面的文献资料,综合评价我国ICU医院感染现状。方法由2位研究人员检索2009—2013年文献资料,数据库包括PubMed、荷兰医学文摘数据库、中国生物医学文献数据库、中国知网、维普数据库及万方数据库,检索主题为综合ICU医院感染目标性监测。对纳入文献进行质量评价与证据评级；提取数据,采用R软件R-3.0.2-win版进行Meta分析与系统评价。检索策略由第三方确定,文献检索、质量评价及证据评级中产生的分歧,均由其组织协商,并予以裁定。结果最终21篇文献纳入定量研究,全部为中文,研究性质均为无对照观察性研究。以感染率为例,合计观察74600例,感染7318例。 Meta分析结果显示,ICU医院感染发生率为：感染率3.27%,例次感染率4.92%,千日感染率4.58‰,例次千日感染率6.49‰(平均病情严重程度调整后)；器械相关感染发病率为：中心静脉插管5.26‰,呼吸机肺炎23.12‰,导尿管2.38‰；感染部位构成比为：下呼吸道58.07%,血流18.16%,尿路15.35%,其他8.43%；病原菌构成比为：鲍曼不动杆菌20.54%,铜绿假单胞菌14.28%,真菌14.35%,金黄色葡萄球菌11.62%,肺炎克雷伯菌10.92%,大肠埃希菌6.86%,其他细菌21.43%。结论 ICU医院感染形势严峻,应进一步加强目标性监测,并采取针对性的有效干预措施。
목적：통과회췌분석여계통평개현유ICU의원감염목표성감측방면적문헌자료,종합평개아국ICU의원감염현상。방법유2위연구인원검색2009—2013년문헌자료,수거고포괄PubMed、하란의학문적수거고、중국생물의학문헌수거고、중국지망、유보수거고급만방수거고,검색주제위종합ICU의원감염목표성감측。대납입문헌진행질량평개여증거평급；제취수거,채용R연건R-3.0.2-win판진행Meta분석여계통평개。검색책략유제삼방학정,문헌검색、질량평개급증거평급중산생적분기,균유기조직협상,병여이재정。결과최종21편문헌납입정량연구,전부위중문,연구성질균위무대조관찰성연구。이감염솔위례,합계관찰74600례,감염7318례。 Meta분석결과현시,ICU의원감염발생솔위：감염솔3.27%,례차감염솔4.92%,천일감염솔4.58‰,례차천일감염솔6.49‰(평균병정엄중정도조정후)；기계상관감염발병솔위：중심정맥삽관5.26‰,호흡궤폐염23.12‰,도뇨관2.38‰；감염부위구성비위：하호흡도58.07%,혈류18.16%,뇨로15.35%,기타8.43%；병원균구성비위：포만불동간균20.54%,동록가단포균14.28%,진균14.35%,금황색포도구균11.62%,폐염극뢰백균10.92%,대장애희균6.86%,기타세균21.43%。결론 ICU의원감염형세엄준,응진일보가강목표성감측,병채취침대성적유효간예조시。
Objective To evaluate the targeted surveillance of health care-associated infections in ICU. Methods PubMed, EMBASE ( Excerpt Medica Database ) , China Biology Medicine disc, China National Knowledge Infrastructure, Vip Journal Integration Platform and Wanfang Data were searched from 2009 to 2013 by two researchers. Full-text studies on targeted surveillance of healthcare-associated infections in ICUs were included. Studies were evacuated using STROBE and GRADE. Random effects meta-analyses were used to generate summary estimates of infection rates. Results Totals of 21 studies met eligibility criteria, which were all Chinese research papers. Taking the infection rate as an example, 74 600 cases were observed within which 7 318 cases were infected. Pooled meta-analyses of eligible studies revealed that adjusted infection rate:infection rate, case infection rate, daily infection rate, case daily infection rate were 3. 27%, 4. 92%, 4. 58‰, 6. 49‰, respectively. The infection rates were 23. 12‰ in ventilator associated pneumonia, 5. 26‰ in catheter-related bloodstream infections, and 2. 38‰ in catheter-associated urinary tract infections. The lower respiratory tract, the blood, and the urinary tract were the main infection sites, accounting for 58. 07%, 18. 16%, and 15. 35%, respectively. A. baumanii, P. Aeruginosa, fungi, S. aureus, K. pneumoniae, E. coli were the main pathogens, accounting for 20. 54%, 14. 28%, 14. 35%, 11. 62%, 10. 92% and 6. 86%, respectively. Conclusions The burden of health-care-associated infection in ICU is high. Our findings indicate a need to improve surveillance and infection-control practices.