抗菌药预防导尿管相关性尿路感染的Meta分析

发布时间：2018-04-04 19:42

本文选题：导尿管　切入点：尿路感染　出处：《中南大学》2014年硕士论文

【摘要】：目的系统评价预防使用抗菌药是否能降低导尿管相关性尿路感染的发生。方法对PUBMED、Cochrane library、Wiley Online Library、相关期刊论文(CNKI)和万方数字化期刊全文数据库的检索,检出发表于1980年1月-2014年3月期间的关于抗菌药预防导尿管相关性尿路感染的随机对照试验,再根据纳入标准(住院患者在留置导尿管前、留置导尿管期间或导尿管拔除后预防性全身使用抗菌药)和排除标准对入选文献进行方法学质量评价、资料提取后,数据用RevMan5.2软件和R软件R2WinBUGS程序包进行Meta分析,并采用GRADE系统评价证据质量和推荐等级。结果根据纳入标准,最终纳入13个英文文献,通过Meta分析结果显示：与对照组比较,抗菌药组能降低拔除导尿管48h内菌尿症发生率(OR值0.14,95%CI[0.05,0.43],P=0.0005),降低预防用药后7d内菌尿症发生率(OR值0.21,95%CI[0.10,0.45],P0.0001),降低单剂量干预后出现的菌尿症发生率(OR值0.4,95%CI[0.28,0.58],P0.00001),降低预防用药后脓尿发生率(OR值0.22,95%CI[0.13,0.38],P0.00001),降低预防用药后尿培养阳性发生率(OR值0.36,95%CI[0.20,0.66],P=0.0009)。两组的不良反应发生和单剂量干预后出现细菌耐药方面无显著性差异。环丙沙星、左氧氟沙星和复方新诺明在预防菌尿症发生无显著性差异。结论对于术前无尿路感染的易感人群(如糖尿病患者、免疫缺陷患者等),围手术期后短期内留置导尿管的患者,预防使用单剂量抗菌药(拔除导尿管前或拔除后48h内)可有效减少继发性尿路感染,且不良反应和细菌耐药性并未增加。
[Abstract]:Objective to systematically evaluate whether the prevention of antibiotic use can reduce urinary tract infection related to urinary tract.
The method of PUBMED, Cochrane library, Wiley Online Library, China Journal Full-text Database (CNKI) and Wanfang digital periodical full-text database, was published in January 1980 -2014 in March on the guide of randomized controlled trials of antibiotics to prevent catheter associated urinary tract infection, according to the inclusion criteria (in hospitalized patients with indwelling catheter before and during catheter or catheter after removal of prophylactic systemic use of antibacterial drugs) and exclusion criteria of the selected documents for methodological quality assessment, data extraction, data analysis was performed using Meta RevMan5.2 software and R R2WinBUGS software package, and the use of GRADE system to assess the quality of evidence and strength of recommendation.
Results according to the inclusion criteria, a total of 13 English literature, through the Meta analysis results showed that: compared with the control group, antibiotic group can reduce the removal of the catheter in 48h bacteriuria incidence (OR = 0.14,95%CI[0.05,0.43], P=0.0005), reduce the preventive medication within 7d after bacteriuria incidence (OR = 0.21,95%CI[0.10,0.45], P0.0001), reduced single dose intervention of bacteriuria incidence (OR = 0.4,95%CI[0.28,0.58], P0.00001), reduce the incidence of pyuria after preventive treatment (OR = 0.22,95%CI[0.13,0.38], P0.00001), decreased after preventive treatment of urine culture positive rate (OR = 0.36,95%CI[0.20,0.66], P=0.0009). The adverse reactions of the two groups and single dose dry the prognosis of bacterial resistance appeared no significant difference. Ciprofloxacin, levofloxacin and cotrimoxazole in prevention of bacteriuria were no significant difference.
Conclusion for the susceptibility to urinary tract infection without preoperative population (such as diabetes, immunodeficiency patients), the patients with indwelling catheter in the short term after the perioperative period, to prevent the use of antibiotics in a single dose (removal of the catheter before or after removal of 48h) can effectively reduce the secondary urinary tract infections, and the adverse reaction and bacterial resistance did not increase.

【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R691.3

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