CC:成人患者体外膜氧合支持期间医院获得性感染的发生率、危险因素和预后：系统评价和meta分析

Abstract

Background：An increasing number of patients requires extracorporeal membrane oxygenation (ECMO) for life support. This supportive modality is associated with nosocomial infections (NIs). This systematic review and meta‐analysis aim to assess the incidence and risk factors of NIs in adult.

背景：越来越多的患者需要体外膜氧合(ECMO)来维持生命。这种支持方式与医院获得性感染(NIs)有关。本系统评价和meta分析旨在评估成人中ECMO相关NIs的发生率和危险因素。

Methods：We searched PubMed, Scopus, Web of Science, and ProQuest databases up to 2022. The primary endpoint was incidence of NI. Secondary endpoints included time to infection, source of infection, ECMO duration, Intensive care and hospital length of stay (LOS), ECMO survival and overall survival. Incidence of NI was reported as pooled proportions and 95% confidence intervals (CIs), while dichotomous outcomes were presented as risk ratios (RR) as the effective index and 95% CIs using a random‐effects model.

方法：我们搜索了PubMed、Scopus、Web of Science和ProQuest数据库，截止到2022年。主要终点是NI的发生率。次要终点包括感染时间、感染来源、ECMO持续时间、重症监护和医院住院时间(LOS)、ECMO存活率和总体存活率。NI的发生率报告为汇总比例和95%置信区间(CIs)，而二元结果则以风险比(RR)作为有效指标和95% CIs呈现，使用随机效应模型。

Results：Among the 4,733 adult patients who received ECMO support in the 30 included studies, 1,249 ECMO‐ related NIs per 1000 ECMO‐days was observed. The pooled incidence of NIs across 18 studies involving 3424 patients was 26% (95% CI 14–38%).Ventilator‐associated pneumonia (VAP) and bloodstream infections (BSI) were the most common NI sources. Infected patients had lower ECMO survival and overall survival rates compared to non‐infected patients, with risk ratio values of 0.84 (95% CI 0.74–0.96, P = 0.01) and 0.80 (95% CI 0.71–0.90, P < 0.001), respectively.

结果：在30项研究中接受ECMO支持的4,733名成人患者中，观察到每1000 ECMO-天有1,249例ECMO相关NIs。在涉及3424名患者的18项研究中，NIs的汇总发生率为26%(95% CI 14–38%)。呼吸机相关肺炎(VAP)和血流感染(BSI)是最常见的NI来源。感染患者的ECMO存活率和总体存活率低于未感染患者，风险比值分别为0.84(95% CI 0.74–0.96, P = 0.01)和0.80(95% CI 0.71–0.90, P < 0.001)。

Conclusion：Results showed that 16% and 20% lower of ECMO survival and overall survival in patients with NI than patients without NI, respectively. However, NI increased the risk of in‐hospital mortality by 37% in infected patients compared with non‐infected patients. In addition, this study identified the significant positive correlation between ECMO duration and ECMO‐related NI.

结论：结果显示，与无NI患者相比，NI患者的ECMO存活率和总体存活率分别低16%和20%。然而，与未感染患者相比，NI使感染患者的住院死亡风险增加了37%。此外，本研究还确定了ECMO持续时间与ECMO相关NI之间的显著正相关。