儿科体外膜肺氧合支持患者院内感染流行病学特征的meta分析

doi:10.3969/j.issn.1004-583X.2025.01.002

摘要/Abstract

摘要：

目的系统评价儿科体外膜肺氧合(ECMO)支持患者院内感染的流行病学特征。方法采用主题词与自由词相结合的方式,系统检索中国知网、万方医学数据库、中国生物医学文献数据库、维普数据库、Pubmed、Embase、web of science数据库,搜集关于儿科ECMO支持患者院内感染的观察性研究,检索时限均为建库到2023年12月。由2名研究者独立进行文献筛选、提取资料、评价纳入研究的偏倚风险后,使用Stata 18.0软件进行meta分析。结果共纳入16项研究,包括3 353例儿科ECMO支持患者,其中发生院内感染患者712例。随机效应模型meta分析结果显示,院内感染发生率为28.55%[95%CI(22.26%,35.28%)]。病原学分布中以革兰阴性菌为主(约占68.68%),其中前3位为:鲍曼不动杆菌(26.93%)、肺炎克雷伯菌(11.90%)、铜绿假单胞菌(9.39%)。结论当前证据显示,儿科ECMO支持患者院内感染率较高,且可能受地域影响。受研究质量影响,上述结论尚待更高质量研究验证。

关键词: 体外膜氧合作用, 院内感染, 发生率, 流行病学, Meta分析

Abstract:

Objective To systematically evaluate the epidemiological characteristics of nosocomial infections in pediatric patients supported by extracorporeal membrane oxygenation (ECMO). Methods A comprehensive search of observational studies related to nosocomial infections in pediatric ECMO patients published from database inception to December 2023 was conducted using a combination of subject terms and free words across multiple databases, including CNKI, Wanfang Medical Database, China Biomedical Literature Database, Weipu Database, Pubmed, Embase, and Web of Science. Two researchers independently screened the literatures, extracted data, and assessed the risk of bias in the included studies. Meta-analysis was performed using Stata 18.0 software. Results A total of 16 studies were included, encompassing 3,353 pediatric patients supported by ECMO, with 712 patients experiencing nosocomial infections. The random effects model in meta-analysis revealed that the overall incidence of nosocomial infections was 28.55% (95% CI [22.26%, 35.28%]). The distribution of pathogens showed that Gram-negative bacteria were predominant (approximately 68.68%), with the top of Acinetobacter baumannii (26.93%), Klebsiella pneumoniae (11.90%), and Pseudomonas aeruginosa (9.39%). Conclusion Current evidence indicates a high rate of nosocomial infections in pediatric patients supported by ECMO, potentially influenced by geographical factors. Due to the impact of study quality, these conclusions require verification through higher-quality research.

Key words: extracorporeal membrane oxygenation, hospital-acquired infections, incidence, epidemiology, meta-analysis

中图分类号:

R654.1

王英, 钟博华, 王丽芳, 朗秋燕, 罗海彬, 王书林, 李春朋, 廖敏. 儿科体外膜肺氧合支持患者院内感染流行病学特征的meta分析[J]. 临床荟萃, 2025, 40(1): 14-20.

Wang Ying, Zhong Bohua, Wang Lifang, Lang Qiuyan, Luo Haibin, Wang Shulin, Li Chunpeng, Liao Min. Epidemiological characteristics of hospital-acquired infections in pediatric patients supported by extracorporeal membrane oxygenation: A meta-analysis[J]. Clinical Focus, 2025, 40(1): 14-20.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2025.01.002

https://huicui.hebmu.edu.cn/CN/Y2025/V40/I1/14

图/表 7

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#1	adolescent^*
#2	child^*
#3	infant^*
#4	pediatric^*
#5	new born^*
#6	babi^*
#7	youth^*
#8	teen^*
#9	toddler^*
#10	preschool^*
#11	#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10
#12	Extracorporeal Membrane Oxygenation
#13	ECMO
#14	Heart-Lung Machine
#15	#11 OR #12 OR #13
#16	cross infection
#17	infect^*
#18	#16 OR #17
#19	#11 OR #15 OR #18

#1	adolescent^*
#2	child^*
#3	infant^*
#4	pediatric^*
#5	new born^*
#6	babi^*
#7	youth^*
#8	teen^*
#9	toddler^*
#10	preschool^*
#11	#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10
#12	Extracorporeal Membrane Oxygenation
#13	ECMO
#14	Heart-Lung Machine
#15	#11 OR #12 OR #13
#16	cross infection
#17	infect^*
#18	#16 OR #17
#19	#11 OR #15 OR #18

纳入研究	发表时间	国家/组织	研究类型	研究时限	样本量	感染组 (例)	非感染组 (例)	文献质量评分 (分)
黄翰武等^[16]	2023	中国	回顾性	2019.01-2023.06	28	20	8	8
杨梦婕等^[17]	2023	中国	回顾性	2017.12-2021.11	21	4	17	8
Cousin等^[18]	2023	瑞士	回顾性	2008.01-2014.12	41	14	27	8
王春乐等^[19]	2022	中国	回顾性	2015.07- 2021.03	38	18	20	8
Işık等^[20]	2022	土耳其	回顾性	2010.01-2020.12	70	24	46	7
Wang等^[21]	2022	中国	回顾性	2012.09-2019.12	190	54	136	8
Yagani等^[22]	2022	印度	回顾性	2016.01-2020.12	106	49	57	7
程东良等^[23]	2021	中国	回顾性	2012.09-2020.02	163	36	127	8
Rodríguez等^[24]	2020	智利	回顾性	2003.01-2016.12	160	38	122	8
Herrup等^[25]	2020	美国	回顾性	2013.01-2015.12	1 314	229	1 085	8
Rambaud等^[26]	2019	法国	回顾性	2010.01-2015.06	90	40	50	7
Cashen等^[27]	2018	美国	前瞻性	2012.12-2014.09	481	80	401	7
Ayyıldız等^[28]	2017	土耳其	回顾性	2011.01-2014.06	66	28	38	7
Butler等^[29]	2017	美国	回顾性	2018.01-2013.10	207	12	195	7
Gardner等^[30]	2012	美国	回顾性	1989.01-2008.12	261	31	230	7
Tse-Chang等^[31]	2011	加拿大	回顾性	1997.05-2007.05	117	35	82	7

纳入研究	发表时间	国家/组织	研究类型	研究时限	样本量	感染组 (例)	非感染组 (例)	文献质量评分 (分)
黄翰武等^[16]	2023	中国	回顾性	2019.01-2023.06	28	20	8	8
杨梦婕等^[17]	2023	中国	回顾性	2017.12-2021.11	21	4	17	8
Cousin等^[18]	2023	瑞士	回顾性	2008.01-2014.12	41	14	27	8
王春乐等^[19]	2022	中国	回顾性	2015.07- 2021.03	38	18	20	8
Işık等^[20]	2022	土耳其	回顾性	2010.01-2020.12	70	24	46	7
Wang等^[21]	2022	中国	回顾性	2012.09-2019.12	190	54	136	8
Yagani等^[22]	2022	印度	回顾性	2016.01-2020.12	106	49	57	7
程东良等^[23]	2021	中国	回顾性	2012.09-2020.02	163	36	127	8
Rodríguez等^[24]	2020	智利	回顾性	2003.01-2016.12	160	38	122	8
Herrup等^[25]	2020	美国	回顾性	2013.01-2015.12	1 314	229	1 085	8
Rambaud等^[26]	2019	法国	回顾性	2010.01-2015.06	90	40	50	7
Cashen等^[27]	2018	美国	前瞻性	2012.12-2014.09	481	80	401	7
Ayyıldız等^[28]	2017	土耳其	回顾性	2011.01-2014.06	66	28	38	7
Butler等^[29]	2017	美国	回顾性	2018.01-2013.10	207	12	195	7
Gardner等^[30]	2012	美国	回顾性	1989.01-2008.12	261	31	230	7
Tse-Chang等^[31]	2011	加拿大	回顾性	1997.05-2007.05	117	35	82	7

病原体分类	病原微生物	例数	构成比(%)
革兰阳性菌		106	22.13
	凝固酶阴性葡萄球菌	9	1.88
	金黄色葡萄球菌	31	6.47
	白色念珠菌	30	6.26
	表皮葡萄球菌	18	3.76
	肺炎链球菌	7	1.46
	粪肠球菌	6	1.25
	链球菌	1	0.21
	沃氏葡萄球菌	2	0.42
	缓症链球菌	1	0.21
	芽孢杆菌	1	0.21
革兰阴性菌		329	68.68
	鲍曼不动杆菌	129	26.93
	铜绿假单胞菌	45	9.39
	肺炎克雷伯菌	57	11.90
	大肠杆菌	37	7.72
	嗜麦芽窄单食胞菌	26	5.43
	洋葱伯克霍尔德氏菌	8	1.67
	少动假单胞菌	5	1.04
	沙雷菌	5	1.04
	流感嗜血杆菌	4	0.84
	阴沟肠杆菌	3	0.63
	支原体	2	0.42
	皮氏霍尔德氏菌	2	0.42
	大肠埃希菌	2	0.42
	嗜肺军团菌	1	0.21
	产酸克雷伯氏菌	1	0.21
	雷氏普罗威登斯菌	1	0.21
	产气肠杆菌	1	0.21
病毒		24	5.01
	流感病毒	8	1.67
	腺病毒	7	1.46
	巨细胞病毒	6	1.25
	EB病毒	1	0.21
	呼吸道合胞病毒	1	0.21
	禽流感病毒	1	0.21
真菌		20	4.18
	假丝酵母菌	15	3.13
	近平滑念珠菌	3	0.63
	耶氏肺孢子菌	2	0.42
其他		6	1.25