Meta-analysis on risk factors for multidrug-resistant organism infections in general ICU patients_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

PAN Huiling ,  ZHANG Chuanlai , SONG Jie , YANG Ruiqi , YE Hongmin

Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;

Corresponding author：

ZHANG Chuanlai, Email: 300429@hospital.cqmu.edu.cn

Keywords：

Multidrug-resistant organisms; infection; intensive care unit; risk factors; meta-analysis

DOI：

10.7507/1671-6205.202408007

Video：

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Objective To systematically assess the risk factors for the occurrence of multidrug-resistant organism (MDRO) infections in general intensive care units (ICU). Methods A computerized search was conducted to identify literature on the risk factors for MDRO infection in ICUs in the Chinese Biomedical Literature Service system, CNKI, Wanfang, VIP, PubMed, Web of Science, Cochrane Library, and Embase databases from January 1, 2012, to June 1, 2024. The literature meeting the inclusion and exclusion criteria was subjected to two-person data extraction and quality evaluation, and then meta-analysis was conducted by using Revman5.4 software. Results A total of 25 articles were included, with a cumulative total of 19 280 patients, including 3 945 patients with MDRO infection (20.5%). Twenty-four risk factors were analyzed, and the difference between 19 of them was statistically significant (P<0.050). The risk factors for MDRO infection included: (1) three general factors: length of hospital stay, ICU length of stay, and APACHE Ⅱ score; (2) seven invasive operation-related factors: mechanical ventilation, duration of mechanical ventilation, fiberoptic bronchoscopy, arterial intubation , length of venous catheterization, ureteral intubation, and urinary catheter retention; (3) four antibiotic-related factors: use of antimicrobials prior to ICU admission, concomitant antimicrobials, antimicrobial species, and duration of antimicrobials use; (4) five factors related to the underlying diseases: hypoproteinemia, pulmonary diseases, combined underlying diseases, number of combined underlying diseases, and mixed infections. Conclusions The current research evidence suggests that multiple factors are associated with the occurrence of MDRO infections in patients in general ICU, which may provide a basis for early screening of patients at risk for MDRO infections by ICU healthcare professionals.

1.	卫生部办公厅关于印发《多重耐药菌医院感染预防与控制技术指南(试行)》的通知. 中华人民共和国卫生部公报, 2011, (2): 59-61.
2.	李文进, 耿苗苗, 杨富, 等. 重症监护室患者多重耐药菌医院感染风险因素管理. 中国卫生资源, 2021, 24(5): 560-564.
3.	Zhou Y, Yu F, Yu Y, et al. Clinical significance of MDRO screening and infection risk factor analysis in the ICU. Am J Transl Res, 2021, 13(4): 3717-3723.
4.	Masse J, Elkalioubie A, Blazejewski C, et al. Colonization pressure as a risk factor of ICU-acquired multidrug resistant bacteria: a prospective observational study. Eur J Clin Microbiol Infect Dis, 2017, 36(5): 797-805.
5.	季亚玲, 王一, 吴苏春, 等. ICU住院患者多药耐药菌感染病原菌耐药性与免疫功能分析. 中华医院感染学杂志, 2018, 28(12): 1779-1782.
6.	Vincent JL, Sakr Y, Singer M, et al. Prevalence and outcomes of infection among patients in intensive care units in 2017. JAMA, 2020, 323(15): 1478-1487.
7.	Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet, 2022, 399(10325): 629-655.
8.	王丹, 朱丹, 夏敏, 等. 预防综合ICU多重耐药菌医院感染的成本效益分析. 中国感染控制杂志, 2021, 20(12): 1119-1125.
9.	国家卫生健康委等13部门联合印发《遏制微生物耐药国家行动计划(2022-2025年)》[EB/OL]. [2024-07-09]. http://mp.weixin.qq.com/s?__biz=MzAxNzMyNzU0Mw==&mid=2650460622&idx=2&sn=4aa7f3002aa8bf466ad9ac404e09947b&chksm=83e94516b49ecc00f084018431f62d0c306b1cf39724440304f952ce6c4caac3b82889e67567#rd.
10.	Wang Y, Wang G, Zhao Y, et al. A deep learning model for predicting multidrug-resistant organism infection in critically ill patients. J Intensive Care, 2023, 11(1): 49.
11.	周芳, 董亚琳. ICU多重耐药菌医院感染的危险因素分析. 中国药房, 2017, 28(14): 1916-1920.
12.	黄文婷, 吴培玉, 黄慧雅, 等. ICU患者多药耐药菌感染的影响因素分析. 中华医院感染学杂志, 2019, 29(21): 3246-3250.
13.	封占辉, 程艳艳, 张汝敏. ICU患者多重耐药菌感染的相关影响因素分析. 饮食保健, 2020, 7(10): 18-19.
14.	王莹, 孙春梅, 贾云华. ICU患者多重耐药菌感染及危险因素分析. 医院管理论坛, 2021, 38(10): 45-47, 83.
15.	Han Y, Zhang J, Zhang H Z, et al. Multidrug-resistant organisms in intensive care units and logistic analysis of risk factors. World J Clin Cases, 2022, 10(6): 1795-1805.
16.	Wu C, Lu J, Ruan L, et al. Tracking epidemiological characteristics and risk factors of multi-drug resistant bacteria in intensive care units. Infect Drug Resist, 2023, 16: 1499-1509.
17.	闫荔. 对导致ICU的患者发生多重耐药菌感染的影响因素分析. 当代医药论丛, 2019, 17(22): 57-58.
18.	池伟文, 李翠玲, 田文龙. 梅县地区重症监护病房多重耐药菌感染现状分析. 山东第一医科大学(山东省医学科学院)学报, 2022, 43(10): 765-769.
19.	阎田园, 梁海峰, 王书会, 等. 某医院ICU住院患者耐药菌感染危险因素分析. 中国消毒学杂志, 2018, 35(2): 114-117.
20.	虞信维. 某院ICU患者感染多重耐药菌危险因素分析. 中国卫生检验杂志, 2020, 30(22): 2799-2801.
21.	项彦斌, 周燕, 杜建成, 等. 重症患者多重耐药菌感染的影响因素及预测模型分析. 重庆医学, 2020, 49(23): 3966-3970.
22.	刘阳. 重症监护病房多重耐药菌感染现状及预警模型构建--以甘肃省某三甲医院为例. 兰州大学公共卫生, 2022.
23.	李娇, 商临萍, 郭红菊, 等. 综合ICU多重耐药菌医院感染的风险模型构建. 中国感染控制杂志, 2016, 15(10): 730-734.
24.	丁梦媛, 李文进, 耿苗苗, 等. 综合重症监护病房患者多重耐药菌医院感染风险评估模型构建. 中国卫生资源, 2020, 23(4): 384-387,399.
25.	李孝雪, 耿苗苗, 祝延红. 综合重症监护室住院患者多重耐药菌的临床分布特点及感染危险因素分析. 中国消毒学杂志, 2024, 41(2): 128-132.
26.	陈慧兰, 游秋萍, 孙萍. ICU多重耐药菌感染的护理防控要点与传播的预警模式构建. 医学食疗与健康, 2021, 19(11): 96-97.
27.	王艳红, 刘艳红. 重症监护病房多重耐药菌的感染类型、耐药机制、耐药性及感染相关因素分析. 吉林医学, 2019, 40(9): 2077-2078.
28.	邰媛媛. 基于随机森林的ICU患者多重耐药菌感染预测模型的研究. 湖州师范学院, 2022.
29.	El M A, Zahlane K, Ait S L, et al. The clinical and epidemiological risk factors of infections due to multi-drug resistant bacteria in an adult intensive care unit of University Hospital Center in Marrakesh-Morocco. J Infect Public Health, 2020, 13(4): 637-643.
30.	Magira E E, Islam S, Niederman M S. Multi-drug resistant organism infections in a medical ICU: Association to clinical features and impact upon outcome. Med Intensiva (Engl Ed), 2018, 42(4): 225-234.
31.	Sonti R, Conroy M E, Welt E M, et al. Modeling risk for developing drug resistant bacterial infections in an MDR-naive critically ill population. Ther Adv Infect Dis, 2017, 4(4): 95-103.
32.	桑玉还, 严忠婷, 袁媛, 等. 重症监护病房患者多重耐药菌感染风险预测模型的系统评价. 中国感染控制杂志, 2023, 22(4): 442-450.
33.	章琦, 李宝珍, 郑雪梅, 等. 2000—2020年中国多重耐药菌研究热点的可视化分析. 中国全科医学, 2022, 25(24): 2960-2964.
34.	陈春江, 罗悦, 卓文玉, 等. 新生儿重症监护病房患儿多重耐药肺炎克雷伯菌耐药情况及危险因素分析. 儿科药学杂志, 2024, 30(3): 28-32.
35.	单荣芳, 姜萍, 严红燕, 等. 神经外科ICU患者多重耐药菌感染危险因素及其与TLR4基因多态性的关联. 中华医院感染学杂志, 2023, 33(13): 1981-1985.
36.	木尼热·艾尼瓦尔, 倪岚, 程真顺, 等. 呼吸重症监护室肺部多重耐药菌的危险因素. 武汉大学学报(医学版), 2024, 45(01): 99-103.
37.	Luo H, Chen X, Jiang Z, et al. Prevalence of and risk factors for intestinal colonisation by multidrug-resistant Gram-negative bacteria in patients with haematological malignancies: A systematic review and meta-analysis. Int J Antimicrob Agents, 2024, 63(1): 107043.
38.	邹倩, 耿苗苗, 祝延红. 基于循证理论构建重症监护病房患者多重耐药菌感染风险预测模型及外部验证研究. 中国全科医学, 2022, 25(12): 1441-1448.
39.	Liberati A, Altman D G, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med, 2009, 6(7): e1000100.
40.	Magiorakos A P, Srinivasan A, Carey R B, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect, 2012, 18(3): 268-281.
41.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
42.	Cumpston M, Li T, Page M J, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, 10(10): D142.
43.	谢朝云, 蒙桂鸾, 覃家露, 等. 中心静脉导管相关性血流多重耐药菌感染危险因素分析. 中国消毒学杂志, 2018, 35(12): 919-921.
44.	张湘湘, 陈坤影, 洪寒萍, 等. 综合干预措施对综合ICU患者导尿管相关尿路感染的影响. 中国卫生标准管理, 2021, 12(11): 122-125.
45.	国家卫生健康委员会. 中国抗菌药物管理和细菌耐药[EB/OL]. [2024-07-09]. http://www.nhc.gov.cn/yzygj/s3594/201904/1b5a42f0e326487295b260c813da9b0e/files/b2df6b4d6eff45a09d9909fd479c9b04.pdf.

1. 卫生部办公厅关于印发《多重耐药菌医院感染预防与控制技术指南(试行)》的通知. 中华人民共和国卫生部公报, 2011, (2): 59-61.
2. 李文进, 耿苗苗, 杨富, 等. 重症监护室患者多重耐药菌医院感染风险因素管理. 中国卫生资源, 2021, 24(5): 560-564.
3. Zhou Y, Yu F, Yu Y, et al. Clinical significance of MDRO screening and infection risk factor analysis in the ICU. Am J Transl Res, 2021, 13(4): 3717-3723.
4. Masse J, Elkalioubie A, Blazejewski C, et al. Colonization pressure as a risk factor of ICU-acquired multidrug resistant bacteria: a prospective observational study. Eur J Clin Microbiol Infect Dis, 2017, 36(5): 797-805.
5. 季亚玲, 王一, 吴苏春, 等. ICU住院患者多药耐药菌感染病原菌耐药性与免疫功能分析. 中华医院感染学杂志, 2018, 28(12): 1779-1782.
6. Vincent JL, Sakr Y, Singer M, et al. Prevalence and outcomes of infection among patients in intensive care units in 2017. JAMA, 2020, 323(15): 1478-1487.
7. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet, 2022, 399(10325): 629-655.
8. 王丹, 朱丹, 夏敏, 等. 预防综合ICU多重耐药菌医院感染的成本效益分析. 中国感染控制杂志, 2021, 20(12): 1119-1125.
9. 国家卫生健康委等13部门联合印发《遏制微生物耐药国家行动计划(2022-2025年)》[EB/OL]. [2024-07-09]. http://mp.weixin.qq.com/s?__biz=MzAxNzMyNzU0Mw==&mid=2650460622&idx=2&sn=4aa7f3002aa8bf466ad9ac404e09947b&chksm=83e94516b49ecc00f084018431f62d0c306b1cf39724440304f952ce6c4caac3b82889e67567#rd.
10. Wang Y, Wang G, Zhao Y, et al. A deep learning model for predicting multidrug-resistant organism infection in critically ill patients. J Intensive Care, 2023, 11(1): 49.
11. 周芳, 董亚琳. ICU多重耐药菌医院感染的危险因素分析. 中国药房, 2017, 28(14): 1916-1920.
12. 黄文婷, 吴培玉, 黄慧雅, 等. ICU患者多药耐药菌感染的影响因素分析. 中华医院感染学杂志, 2019, 29(21): 3246-3250.
13. 封占辉, 程艳艳, 张汝敏. ICU患者多重耐药菌感染的相关影响因素分析. 饮食保健, 2020, 7(10): 18-19.
14. 王莹, 孙春梅, 贾云华. ICU患者多重耐药菌感染及危险因素分析. 医院管理论坛, 2021, 38(10): 45-47, 83.
15. Han Y, Zhang J, Zhang H Z, et al. Multidrug-resistant organisms in intensive care units and logistic analysis of risk factors. World J Clin Cases, 2022, 10(6): 1795-1805.
16. Wu C, Lu J, Ruan L, et al. Tracking epidemiological characteristics and risk factors of multi-drug resistant bacteria in intensive care units. Infect Drug Resist, 2023, 16: 1499-1509.
17. 闫荔. 对导致ICU的患者发生多重耐药菌感染的影响因素分析. 当代医药论丛, 2019, 17(22): 57-58.
18. 池伟文, 李翠玲, 田文龙. 梅县地区重症监护病房多重耐药菌感染现状分析. 山东第一医科大学(山东省医学科学院)学报, 2022, 43(10): 765-769.
19. 阎田园, 梁海峰, 王书会, 等. 某医院ICU住院患者耐药菌感染危险因素分析. 中国消毒学杂志, 2018, 35(2): 114-117.
20. 虞信维. 某院ICU患者感染多重耐药菌危险因素分析. 中国卫生检验杂志, 2020, 30(22): 2799-2801.
21. 项彦斌, 周燕, 杜建成, 等. 重症患者多重耐药菌感染的影响因素及预测模型分析. 重庆医学, 2020, 49(23): 3966-3970.
22. 刘阳. 重症监护病房多重耐药菌感染现状及预警模型构建--以甘肃省某三甲医院为例. 兰州大学公共卫生, 2022.
23. 李娇, 商临萍, 郭红菊, 等. 综合ICU多重耐药菌医院感染的风险模型构建. 中国感染控制杂志, 2016, 15(10): 730-734.
24. 丁梦媛, 李文进, 耿苗苗, 等. 综合重症监护病房患者多重耐药菌医院感染风险评估模型构建. 中国卫生资源, 2020, 23(4): 384-387,399.
25. 李孝雪, 耿苗苗, 祝延红. 综合重症监护室住院患者多重耐药菌的临床分布特点及感染危险因素分析. 中国消毒学杂志, 2024, 41(2): 128-132.
26. 陈慧兰, 游秋萍, 孙萍. ICU多重耐药菌感染的护理防控要点与传播的预警模式构建. 医学食疗与健康, 2021, 19(11): 96-97.
27. 王艳红, 刘艳红. 重症监护病房多重耐药菌的感染类型、耐药机制、耐药性及感染相关因素分析. 吉林医学, 2019, 40(9): 2077-2078.
28. 邰媛媛. 基于随机森林的ICU患者多重耐药菌感染预测模型的研究. 湖州师范学院, 2022.
29. El M A, Zahlane K, Ait S L, et al. The clinical and epidemiological risk factors of infections due to multi-drug resistant bacteria in an adult intensive care unit of University Hospital Center in Marrakesh-Morocco. J Infect Public Health, 2020, 13(4): 637-643.
30. Magira E E, Islam S, Niederman M S. Multi-drug resistant organism infections in a medical ICU: Association to clinical features and impact upon outcome. Med Intensiva (Engl Ed), 2018, 42(4): 225-234.
31. Sonti R, Conroy M E, Welt E M, et al. Modeling risk for developing drug resistant bacterial infections in an MDR-naive critically ill population. Ther Adv Infect Dis, 2017, 4(4): 95-103.
32. 桑玉还, 严忠婷, 袁媛, 等. 重症监护病房患者多重耐药菌感染风险预测模型的系统评价. 中国感染控制杂志, 2023, 22(4): 442-450.
33. 章琦, 李宝珍, 郑雪梅, 等. 2000—2020年中国多重耐药菌研究热点的可视化分析. 中国全科医学, 2022, 25(24): 2960-2964.
34. 陈春江, 罗悦, 卓文玉, 等. 新生儿重症监护病房患儿多重耐药肺炎克雷伯菌耐药情况及危险因素分析. 儿科药学杂志, 2024, 30(3): 28-32.
35. 单荣芳, 姜萍, 严红燕, 等. 神经外科ICU患者多重耐药菌感染危险因素及其与TLR4基因多态性的关联. 中华医院感染学杂志, 2023, 33(13): 1981-1985.
36. 木尼热·艾尼瓦尔, 倪岚, 程真顺, 等. 呼吸重症监护室肺部多重耐药菌的危险因素. 武汉大学学报(医学版), 2024, 45(01): 99-103.
37. Luo H, Chen X, Jiang Z, et al. Prevalence of and risk factors for intestinal colonisation by multidrug-resistant Gram-negative bacteria in patients with haematological malignancies: A systematic review and meta-analysis. Int J Antimicrob Agents, 2024, 63(1): 107043.
38. 邹倩, 耿苗苗, 祝延红. 基于循证理论构建重症监护病房患者多重耐药菌感染风险预测模型及外部验证研究. 中国全科医学, 2022, 25(12): 1441-1448.
39. Liberati A, Altman D G, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med, 2009, 6(7): e1000100.
40. Magiorakos A P, Srinivasan A, Carey R B, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect, 2012, 18(3): 268-281.
41. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
42. Cumpston M, Li T, Page M J, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, 10(10): D142.
43. 谢朝云, 蒙桂鸾, 覃家露, 等. 中心静脉导管相关性血流多重耐药菌感染危险因素分析. 中国消毒学杂志, 2018, 35(12): 919-921.
44. 张湘湘, 陈坤影, 洪寒萍, 等. 综合干预措施对综合ICU患者导尿管相关尿路感染的影响. 中国卫生标准管理, 2021, 12(11): 122-125.
45. 国家卫生健康委员会. 中国抗菌药物管理和细菌耐药[EB/OL]. [2024-07-09]. http://www.nhc.gov.cn/yzygj/s3594/201904/1b5a42f0e326487295b260c813da9b0e/files/b2df6b4d6eff45a09d9909fd479c9b04.pdf.

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Latest ArticlesMeta-analysis on risk factors for multidrug-resistant organism infections in general ICU patients

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