系统评价中国新生儿发生抗菌药物相关性腹泻的危险因素
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摘要
目的系统评价中国新生儿患者发生抗菌药物相关性腹泻(antibiotic-associated diarrhea,AAD)的危险因素。方法检索PubMed、Embase、CNKI、VIP、CBM、万方等相关数据库,收集中国新生儿患者发生AAD危险因素的病例对照研究,检索年限为数据库建库至2018年3月,采用纽卡斯尔-渥太华质量评估量表对纳入文献进行质量评价,并应用RevMan 5.2软件进行meta分析。结果共纳入15篇文献,涉及6838例患儿,其中AAD组1038例,非AAD组5800例。Meta分析结果显示,AAD的危险因素为侵袭性操作(OR=3.70,95%CI=3.16～4.34,P<0.01)、住院时间≥15 d(OR=3.12,95%CI=2.57～3.79,P<0.01)、胎龄<37周(OR=2.56,95%CI=2.11～3.11,P<0.01)、日龄<7 d(OR=2.56,95%CI=2.10～3.13,P<0.01)、出生时体质量<2.5 kg(OR=1.89,95%CI=1.54～2.33,P<0.01)、抗菌药物联用(OR=1.49,95%CI=1.15～1.94,P=0.003)和母乳喂养(OR=0.69,95%CI=0.53～0.90,P=0.007)。结论低胎龄、出生时低体质量、出生日龄偏小、抗菌药物联用、侵袭性操作、住院时间过长及非母乳喂养是新生儿发生AAD的危险因素。
OBJECTIVE To evaluate the risk factors for antibiotic-associated diarrhea(AAD) in Chinese neonates.METHODS The related databases of PubMed,Embase,CNKI,VIP,CBM,and Wanfang were electronically searched for the case-control studies about risk factors for AAD in neonates from database building to March 2018. The quality of the literature evaluated by Newcastle Ottawa Scale,and then meta-analysis was conducted using RevMan 5.2 software. RESULTS Total of 15 studies involving and 6 838 patients were entered, including 1 038 in the AAD group and 5 800 in the non-AAD group. The result of meta analysis showed that invasive operation(OR=3.70, 95%CI=3.16-4.34, P<0.01), hospital stay ≥15 d(OR=3.12, 95%CI=2.57-3.79, P<0.01), fetal age < 37 w(OR=2.56, 95%CI=2.11-3.11, P<0.01), age days<7 d(OR=2.56,95%CI=2.10-3.13, P<0.01), birth weight < 2.5 kg(OR=1.89, 95%CI=1.54-2.33, P<0.01), antibiotics combination(OR=1.49,95%CI=1.15-1.94, P=0.003) and non-breastfeeding(OR=0.69, 95%CI=0.53-0.90, P=0.007) were risk factors for AAD in Chinese neonates. CONCLUSION Current evidence shows that low gestational age, low birth weight, low birth age, antibiotic combination, invasive operation, long hospital stay, non-breastfeeding are risk factors for AAD in neonates.
OBJECTIVE To evaluate the risk factors for antibiotic-associated diarrhea(AAD) in Chinese neonates.METHODS The related databases of PubMed,Embase,CNKI,VIP,CBM,and Wanfang were electronically searched for the case-control studies about risk factors for AAD in neonates from database building to March 2018. The quality of the literature evaluated by Newcastle Ottawa Scale,and then meta-analysis was conducted using RevMan 5.2 software. RESULTS Total of 15 studies involving and 6 838 patients were entered, including 1 038 in the AAD group and 5 800 in the non-AAD group. The result of meta analysis showed that invasive operation(OR=3.70, 95%CI=3.16-4.34, P<0.01), hospital stay ≥15 d(OR=3.12, 95%CI=2.57-3.79, P<0.01), fetal age < 37 w(OR=2.56, 95%CI=2.11-3.11, P<0.01), age days<7 d(OR=2.56,95%CI=2.10-3.13, P<0.01), birth weight < 2.5 kg(OR=1.89, 95%CI=1.54-2.33, P<0.01), antibiotics combination(OR=1.49,95%CI=1.15-1.94, P=0.003) and non-breastfeeding(OR=0.69, 95%CI=0.53-0.90, P=0.007) were risk factors for AAD in Chinese neonates. CONCLUSION Current evidence shows that low gestational age, low birth weight, low birth age, antibiotic combination, invasive operation, long hospital stay, non-breastfeeding are risk factors for AAD in neonates.
引文
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[17]王祥,田兆方.布拉酵母菌预防新生儿抗生素相关性腹泻疗效的临床研究[J].山西医药杂志,2012(9):905-907.
[18]陈阵.新生儿抗生素相关性腹泻的因素分析[J].中国基层医药,2008,15(7):1163.
[19]黄艳.新生儿抗生素相关性腹泻的相关因素分析[J].中国处方药,2017,15(10):27-28.
[20]BARTLETT J G.Antibiotic-associated diarrhea[J].N Engl JMed,2002,346(5):334-339.
[21]REVELES K R,LEE G C,BOYD N K,et al.The rise in Clostridium difficile infection incidence among hospitalized adults in the United States:2001-2010[J].Am J Infect Control,2014,42(10):1028-1032.
[22]LIU H,XU X L,ZHANG R.Advances in laboratory testing for Clostridium difficile infection[J].Chin J Infect Control,(中国感染控制杂志),2017,16(1):89-93.
[23]沈晓明,王卫平.儿科学[M].北京:人民卫生出版社,2005.
[24]QI H X,CHEN P Y,YUAN S L.Diseases in the Neonatal period among preterm infants:an epidemiological investigation[J].Chin J Contemp Pediatr(中国当代儿科杂志),2012,14(1):11-14.
[25]MI X J,ZHAO S Y,WANG J C,et al.Epidemiological investigation of neonatal infection in 2014[J].Chin JNosocomiol(中华医院感染学杂志),2015,25(17):4039-4040.
[26]SU Z Q,KE D H,FANG W M.Clinical study on 786 cases of antibiotic-associated diarrhea in infants by microecological preparations[J].Chin J Postgrad Med(中国医师进修杂志),2009,32(12):63-64.
[27]XU H B,JIANG R H,SHENG H B.Meta-analysis of the effects of Bifidobacterium preparations for the prevention and treatment of pediatric antibiotic-associated diarrhea in China[J].Complement Ther Med,2017(33):105-113.
[28]LI W M,DA R,CAO H,et al.The clinical application and prospects of intestinal probiotics on the control of Clostridium difficile-associated diarrhea[J].Chin J Microecology(中国微生态学杂志),2013,25(5):600-603.
[2]LIAO Y,LIU Z Y.The research advancement of antibiotic associated marrhea in chndren[J].J Pediatric Pharm(儿科药学杂志),2008,14(6):55-57.
[3]中华人民共和国卫生部药品标准藏药[M].中华人民共和国卫生部药品委员会,1990.
[4]STANG A.Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J].Eur J Epidemiol,2010,25(9):603-605.
[5]凌赛泳,童汝雁,陆金海.新生儿抗生素相关性腹泻临床特征及预防[J].中国儿童保健杂志,2007,15(6):663-665.
[6]SHI Z L.Clinical research of antibiotic-associated diarrhea in the newborns[J].Qingdao Med J,2008,40(1):15-16.
[7]SUN L P.Risk factors for antibiotic-associated diarrhea in neonatal:A case-control study[J].Chin J Postgrad Med(中国医师进修杂志),2008,31(10):43-44.
[8]DAI Q Q.Clinical studies of 50 cases of antibiotic-associated diarrhea in neonatal[J].Zhejiang J Integr Tradit Chin West Med(浙江中西医结合杂志),2007,17(7):437-438.
[9]李沙沙.新生儿抗生素相关性腹泻的临床观察及护理[J].现代医药卫生,2007,23(23):3520-3521.
[10]LI J C,MAI H Y.Clinical analysis on relative factors of antibiotic associated diarrhea in neonates[J].China Healthc Front(中国医疗前沿),2009,4(15):10-11.
[11]杨勇.儿科抗生素相关性腹泻的相关因素[J].大家健康,2017,11(4):152-153.
[12]梁建梅,李志毅.新生儿抗生素相关性腹泻的危险因素分析[J].中国全科医学,2005(20):1696-1697.
[13]殷海燕.新生儿抗生素相关性腹泻的临床探究[J].当代医学,2017,23(8):98-100.
[14]JIANG Y.Related factors for antibiotics-associated diarrhea in neonates[J].Chin J Nosocomiology(中华医院感染学杂志),2012,22(22):5047-5048,5051.
[15]潘瑞.新生儿抗生素相关性腹泻的临床研究[J].包头医学,2012,36(4):219-221.
[16]王宗升,宗自库,韩全乡,等.新生儿抗生素相关性腹泻临床研究[J].实用儿科临床杂志,2003(8):613,616.
[17]王祥,田兆方.布拉酵母菌预防新生儿抗生素相关性腹泻疗效的临床研究[J].山西医药杂志,2012(9):905-907.
[18]陈阵.新生儿抗生素相关性腹泻的因素分析[J].中国基层医药,2008,15(7):1163.
[19]黄艳.新生儿抗生素相关性腹泻的相关因素分析[J].中国处方药,2017,15(10):27-28.
[20]BARTLETT J G.Antibiotic-associated diarrhea[J].N Engl JMed,2002,346(5):334-339.
[21]REVELES K R,LEE G C,BOYD N K,et al.The rise in Clostridium difficile infection incidence among hospitalized adults in the United States:2001-2010[J].Am J Infect Control,2014,42(10):1028-1032.
[22]LIU H,XU X L,ZHANG R.Advances in laboratory testing for Clostridium difficile infection[J].Chin J Infect Control,(中国感染控制杂志),2017,16(1):89-93.
[23]沈晓明,王卫平.儿科学[M].北京:人民卫生出版社,2005.
[24]QI H X,CHEN P Y,YUAN S L.Diseases in the Neonatal period among preterm infants:an epidemiological investigation[J].Chin J Contemp Pediatr(中国当代儿科杂志),2012,14(1):11-14.
[25]MI X J,ZHAO S Y,WANG J C,et al.Epidemiological investigation of neonatal infection in 2014[J].Chin JNosocomiol(中华医院感染学杂志),2015,25(17):4039-4040.
[26]SU Z Q,KE D H,FANG W M.Clinical study on 786 cases of antibiotic-associated diarrhea in infants by microecological preparations[J].Chin J Postgrad Med(中国医师进修杂志),2009,32(12):63-64.
[27]XU H B,JIANG R H,SHENG H B.Meta-analysis of the effects of Bifidobacterium preparations for the prevention and treatment of pediatric antibiotic-associated diarrhea in China[J].Complement Ther Med,2017(33):105-113.
[28]LI W M,DA R,CAO H,et al.The clinical application and prospects of intestinal probiotics on the control of Clostridium difficile-associated diarrhea[J].Chin J Microecology(中国微生态学杂志),2013,25(5):600-603.