糖尿病足溃疡患者多重耐药菌感染危险因素的Meta分析

Meta-analysis on risk factors for multidrug-resistant organism infection in patients with diabetic foot ulcer

摘要:

目的 通过Meta分析明确糖尿病足溃疡患者感染多重耐药菌（MDRO）的危险因素。方法 检索数据库有关糖尿病足溃疡患者感染MDRO危险因素的文献，按照纳入和排除标准筛选文献，由两名研究者独立进行资料提取和质量评价，采用RevMan 5.3统计分析软件进行Meta分析。结果 共纳入文献20篇，总样本量为2 568例。纳入分析的危险因素共13个，经Meta分析结果表明，足溃疡病程[WMD=5.25，95%CI（0.13~10.37），P=0.04]、缺血性溃疡[OR=2.84，95%CI（2.25~3.60），P<0.001]、溃疡面积[OR=2.43，95%CI（1.58~3.72），P<0.001]、因同一溃疡住院次数>2次[OR=16.82，95%CI（10.85~26.09），P<0.001]、抗菌药物暴露史[OR=5.86，95%CI（3.79~9.07），P<0.001]、曾经应用第三代头孢菌素[OR=5.15，95%CI（3.51~7.56），P<0.001]、合并骨髓炎[OR=7.22，95%CI（4.45~11.69），P<0.001]、糖尿病肾病[OR=1.41，95%CI（1.12~1.76），P=0.003]以及贫血[OR=3.18，95%CI（2.04~4.95），P<0.001]为MDRO感染的危险因素。结论 足溃疡病程越长、缺血性溃疡、溃疡面积越大、住院次数越多、有抗菌药物应用史以及合并骨髓炎、糖尿病肾病及贫血的患者MDRO感染的风险越高，医护人员应及时识别相关危险因素并积极采取措施预防MDRO感染的发生。

Abstract:

Objective To identify risk factors for multidrug-resistant organism(MDRO) infection in patients with diabetic foot ulcer(DFU) by Meta-analysis. Methods Literatures on risk factors for MDRO infection in patients with DFU were retrieved and screened according to inclusion and exclusion criteria, data were extracted and performed quality assessment independently by two researchers, Meta-analysis was performed using RevMan 5.3 statistical analysis software. Results A total of 20 articles were included, with a total samples of 2 568 cases. There were 13 risk factors were included in the analysis, Meta analysis showed that risk factors for MDRO infection were course of foot ulcer (WMD, 5.25[95%CI, 0.13-10.37], P=0.04), ischemic ulcer (OR, 2.84[95%CI, 2.25-3.60], P<0.001), ulcer area (OR, 2.43[95%CI, 1.58-3.72], P<0.001), number of hospitalization due to the same ulcer>2 times(OR, 16.82[95%CI, 10.85-26.09], P<0.001), history of antimicrobial exposure(OR, 5.86[95%CI, 3.79-9.07], P<0.001), use of third generation cephalosporins (OR, 5.15[95%CI, 3.51-7.56], P<0.001), complicated osteomyelitis(OR, 7.22[95%CI, 4.45-11.69], P<0.001), diabetic nephropathy(OR, 1.41[95%CI, 1.12-1.76], P=0.003), and anemia(OR, 3.18[95%CI, 2.04-4.95], P<0.001). Conclusion Risk of MDRO infection is higher in DFU patients with long course of foot ulcer, ischemic ulcer, larger area of ulcer, the more times of hospitalization, history of antimicrobial use, combined osteomyelitis, diabetic nephropathy, and anemia, health care workers should identify relevant risk factors in time and take active measures to prevent the occurrence of MDRO infection.