中国综合性医院院内感染病原菌分布的Meta分析

黄娅铃; 张帆; 谭斌; 张弦; 薛健; 周锡鹏; 李迎丽; 邱景富

文章摘要

黄娅铃,张帆,谭斌,张弦,薛健,周锡鹏,李迎丽,邱景富.中国综合性医院院内感染病原菌分布的Meta分析[J].中华流行病学杂志,2013,34(11):1134-1138

中国综合性医院院内感染病原菌分布的Meta分析

istribution of the of nosocomial infection pathogens among general hospital in China：a Metaanalysis

收稿日期:2013-06-14 出版日期:2014-10-16

DOI：10.3760/cma.j.issn.0254-6450.2013.011.020

中文关键词: 医院感染病原菌 Meta分析

英文关键词: ospitalinfection Pathogen Meta.Analysis

基金项目:国家自然科学基金(31071093，31170129，31200064)；重庆市科委攻关项目(201IGGB062

作者	单位	E-mail
黄娅铃	400016 重庆医科大学公共卫生与管理学院
张帆	400016 重庆医科大学公共卫生与管理学院
谭斌	400016 重庆医科大学公共卫生与管理学院
张弦	400016 重庆医科大学公共卫生与管理学院
薛健	400016 重庆医科大学公共卫生与管理学院
周锡鹏	400016 重庆医科大学公共卫生与管理学院
李迎丽	400016 重庆医科大学公共卫生与管理学院	liylyl@yahoo.com.cn
邱景富	400016 重庆医科大学公共卫生与管理学院

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中文摘要:

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：o.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%C1：2.3%-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%C1：0.1%～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。

英文摘要:

0bjective To provide basic and direction for nosocomial infection prevention andcontrol through evaluation the distribution of nosocomialinfection pathogens and understand currentsituation of pathogens among general hospital i11 China.Methods Articles were searched andcollected from CBM,CNKI,VIP database and Wanfang database published between creating databaseto March.20 l 3 about investigation of nosocomial infection.Those Iiteratures were screened andextracted according to the inclusion and exclusion criteria by two reviewers independently.Theanalysis of pathogens distribution was performed by using comprehensive Meta analysis software andstratified by factor as year.hospital level and region of the study.The distribution rate of differentpathogens were merged according to statistical tests for the heterogeneity test.Results The 345 trialswere included.The results show 1)the pooled distribution rates of common pathogens in l987-2000were as f01lows：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 200 l-20 1 2 were as follows：l 7.6%(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,Pseudomonus.and Klebsiella respectively.2)The pooleddistribution rates ofpathogens 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%C,：0.6%-5.1%),4.3%(95%CI：2.3%-8.0%)for Mycoplasma,Shigella and Alkaligenes respectively.3)The pooled rate of Mycoplusma for Yangtze River Economic Area was14.3%(95%CI：2.0%-58.1%)andfor SouthwestEconomicAreawas 0.3%(95%CI：0.1%-1.1%).Thepooled rate of Corynebacterium for YangtzeRiverEconomicAreawas 0.4%(95%CI：0.1％-1.4%)andfor Southeast Economic Area was 9.5%(95%CI：2.4%-3 1.1%).The pooled rate of Haemophilus forNorthem 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.Pseudolnotus and Escherichia among general hospitals in China.A remarkable note iS that Klebsiellawas increased significantly in recent years and becomes one of the most common pathogens.Therewere differences in the distribution rate of nosocomial infection pathogens among general hospitalsbetween levels and regions in China.

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