成人家庭肠外营养患者PICC导管相关血流感染发病率的Meta分析

 目的 比较成人家庭肠外营养(HPN)患者经外周静脉穿刺置入中心静脉导管(PICC)与中心静脉导管(CVC)的导管相关血流感染(CRBSI)发病率,为HPN患者选择合适的静脉血管通路装置提供证据支持。方法 计算机检索Cochrane图书馆、JBI图书馆、Pubmed、Embase、Ovid、Web of Science、中国生物医学文献数据库、维普数据库、万方及中国知网建库至2019年3月关于HPN患者CRBSI发病率的研究,应用Stata 13.0进行Meta分析。结果 共纳入9篇队列研究文献,1 407例患者。Meta分析结果显示,使用PICC的HPN患者CRBSI发病率低于CVC (12.14% VS 37.18%,RR=0.42,95%CI:0.34~0.52)。有6篇文献报道CRBSI日发病率,结果显示PICC的CRBSI发病率低于CVC(12.97% VS 37.21%,RR=0.37,95%CI:0.23~0.60)。亚组分析结果显示,不同PICC置管方式组(超声引导、X线检查、未报道组)、报道CRBSI的诊断方法组、不同血管导管使用日数组(报道和未报道组)、报道感染菌群种类组PICC患者CRBSI发病率均低于CVC患者,差异均有统计学意义(均P<0.05)。结论 与CVC相比,成人HPN患者选择PICC进行治疗时CRBSI的发生风险较低。

Prevalence of healthcare-associated infection in patients with coronavirus disease 2019

Objective To compare the incidence of catheter-related bloodstream infection (CRBSI) in adult patients receiving home parenteral nutrition (HPN) through peripherally inserted central catheter (PICC) and central venous catheter (CVC), and provide evidence for selecting suitable venous access devices in HPN patients. Methods Studies about CRBSI incidence in HPN patients were searched by computer from Cochrane Library, JBI Library, PubMed, Embase, Ovid, Web of Science, China Biomedical Literature Database(CBM), VIP Database, Wanfang and China National Knowledge Infrastructure(CNKI) from the establishment to March 2019, Stata 13.0 was used to perform Meta-analysis. Results A total of 1 407 patients in 9 cohort studies were included in the analysis. Meta-analysis results showed that the incidence of CRBSI in HPN patients using PICC was lower than that in HPN patients using CVC (12.14% vs 37.18%, RR=0.42, 95% CI:0.34-0.52). Six literatures reported the incidence of CRBSI per 1 000 catheter days, results showed that incidence of CRBSI in PICC was lower than that in CVC (12.97% vs 37.21%, RR=0.37, 95% CI:0.23-0.60). Subgroup analysis results showed that incidence of CRBSI in patients in PICC group were all lower than CVC group in the following subgroups:different PICC placement groups (ultrasound guidance, X-ray examination, unreported), reported CRBSI diagnostic method group, different vascular catheterization day groups (reported group and unreported group), and reported infectious flora species group, differences were all statistically significant (all P<0.05). Conclusion Compared with CVC, the risk of CRBSI is lower when adult HPN patients choose PICC for treatment.