Meta-analysis on risk factors for multidrug-resistant organism infections in general ICU patients_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

PAN Huiling ,  ZHANG Chuanlai , SONG Jie , YANG Ruiqi , YE Hongmin

Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;

Corresponding?author：

ZHANG Chuanlai, Email: 300429@hospital.cqmu.edu.cn

Keywords：

Multidrug-resistant organisms; infection; intensive care unit; risk factors; meta-analysis

DOI：

10.7507/1671-6205.202408007

Video：

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Objective To systematically assess the risk factors for the occurrence of multidrug-resistant organism (MDRO) infections in general intensive care units (ICU). Methods A computerized search was conducted to identify literature on the risk factors for MDRO infection in ICUs in the Chinese Biomedical Literature Service system, CNKI, Wanfang, VIP, PubMed, Web of Science, Cochrane Library, and Embase databases from January 1, 2012, to June 1, 2024. The literature meeting the inclusion and exclusion criteria was subjected to two-person data extraction and quality evaluation, and then meta-analysis was conducted by using Revman5.4 software. Results A total of 25 articles were included, with a cumulative total of 19 280 patients, including 3 945 patients with MDRO infection (20.5%). Twenty-four risk factors were analyzed, and the difference between 19 of them was statistically significant (P<0.050). The risk factors for MDRO infection included: (1) three general factors: length of hospital stay, ICU length of stay, and APACHE Ⅱ score; (2) seven invasive operation-related factors: mechanical ventilation, duration of mechanical ventilation, fiberoptic bronchoscopy, arterial intubation , length of venous catheterization, ureteral intubation, and urinary catheter retention; (3) four antibiotic-related factors: use of antimicrobials prior to ICU admission, concomitant antimicrobials, antimicrobial species, and duration of antimicrobials use; (4) five factors related to the underlying diseases: hypoproteinemia, pulmonary diseases, combined underlying diseases, number of combined underlying diseases, and mixed infections. Conclusions The current research evidence suggests that multiple factors are associated with the occurrence of MDRO infections in patients in general ICU, which may provide a basis for early screening of patients at risk for MDRO infections by ICU healthcare professionals.

Citation： PAN Huiling, ZHANG Chuanlai, SONG Jie, YANG Ruiqi, YE Hongmin. Meta-analysis on risk factors for multidrug-resistant organism infections in general ICU patients. Chinese Journal of Respiratory and Critical Care Medicine, 2025, 24(5): 305-312. doi: 10.7507/1671-6205.202408007 Copy

1.	衛生部辦公廳關于印發《多重耐藥菌醫院感染預防與控制技術指南(試行)》的通知. 中華人民共和國衛生部公報, 2011, (2): 59-61.
2.	李文進, 耿苗苗, 楊富, 等. 重癥監護室患者多重耐藥菌醫院感染風險因素管理. 中國衛生資源, 2021, 24(5): 560-564.
3.	Zhou Y, Yu F, Yu Y, et al. Clinical significance of MDRO screening and infection risk factor analysis in the ICU. Am J Transl Res, 2021, 13(4): 3717-3723.
4.	Masse J, Elkalioubie A, Blazejewski C, et al. Colonization pressure as a risk factor of ICU-acquired multidrug resistant bacteria: a prospective observational study. Eur J Clin Microbiol Infect Dis, 2017, 36(5): 797-805.
5.	季亞玲, 王一, 吳蘇春, 等. ICU住院患者多藥耐藥菌感染病原菌耐藥性與免疫功能分析. 中華醫院感染學雜志, 2018, 28(12): 1779-1782.
6.	Vincent JL, Sakr Y, Singer M, et al. Prevalence and outcomes of infection among patients in intensive care units in 2017. JAMA, 2020, 323(15): 1478-1487.
7.	Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet, 2022, 399(10325): 629-655.
8.	王丹, 朱丹, 夏敏, 等. 預防綜合ICU多重耐藥菌醫院感染的成本效益分析. 中國感染控制雜志, 2021, 20(12): 1119-1125.
9.	國家衛生健康委等13部門聯合印發《遏制微生物耐藥國家行動計劃(2022-2025年)》[EB/OL]. [2024-07-09].
10.	Wang Y, Wang G, Zhao Y, et al. A deep learning model for predicting multidrug-resistant organism infection in critically ill patients. J Intensive Care, 2023, 11(1): 49.
11.	周芳, 董亞琳. ICU多重耐藥菌醫院感染的危險因素分析. 中國藥房, 2017, 28(14): 1916-1920.
12.	黃文婷, 吳培玉, 黃慧雅, 等. ICU患者多藥耐藥菌感染的影響因素分析. 中華醫院感染學雜志, 2019, 29(21): 3246-3250.
13.	封占輝, 程艷艷, 張汝敏. ICU患者多重耐藥菌感染的相關影響因素分析. 飲食保健, 2020, 7(10): 18-19.
14.	王瑩, 孫春梅, 賈云華. ICU患者多重耐藥菌感染及危險因素分析. 醫院管理論壇, 2021, 38(10): 45-47, 83.
15.	Han Y, Zhang J, Zhang H Z, et al. Multidrug-resistant organisms in intensive care units and logistic analysis of risk factors. World J Clin Cases, 2022, 10(6): 1795-1805.
16.	Wu C, Lu J, Ruan L, et al. Tracking epidemiological characteristics and risk factors of multi-drug resistant bacteria in intensive care units. Infect Drug Resist, 2023, 16: 1499-1509.
17.	閆荔. 對導致ICU的患者發生多重耐藥菌感染的影響因素分析. 當代醫藥論叢, 2019, 17(22): 57-58.
18.	池偉文, 李翠玲, 田文龍. 梅縣地區重癥監護病房多重耐藥菌感染現狀分析. 山東第一醫科大學(山東省醫學科學院)學報, 2022, 43(10): 765-769.
19.	閻田園, 梁海峰, 王書會, 等. 某醫院ICU住院患者耐藥菌感染危險因素分析. 中國消毒學雜志, 2018, 35(2): 114-117.
20.	虞信維. 某院ICU患者感染多重耐藥菌危險因素分析. 中國衛生檢驗雜志, 2020, 30(22): 2799-2801.
21.	項彥斌, 周燕, 杜建成, 等. 重癥患者多重耐藥菌感染的影響因素及預測模型分析. 重慶醫學, 2020, 49(23): 3966-3970.
22.	劉陽. 重癥監護病房多重耐藥菌感染現狀及預警模型構建--以甘肅省某三甲醫院為例. 蘭州大學公共衛生, 2022.
23.	李嬌, 商臨萍, 郭紅菊, 等. 綜合ICU多重耐藥菌醫院感染的風險模型構建. 中國感染控制雜志, 2016, 15(10): 730-734.
24.	丁夢媛, 李文進, 耿苗苗, 等. 綜合重癥監護病房患者多重耐藥菌醫院感染風險評估模型構建. 中國衛生資源, 2020, 23(4): 384-387,399.
25.	李孝雪, 耿苗苗, 祝延紅. 綜合重癥監護室住院患者多重耐藥菌的臨床分布特點及感染危險因素分析. 中國消毒學雜志, 2024, 41(2): 128-132.
26.	陳慧蘭, 游秋萍, 孫萍. ICU多重耐藥菌感染的護理防控要點與傳播的預警模式構建. 醫學食療與健康, 2021, 19(11): 96-97.
27.	王艷紅, 劉艷紅. 重癥監護病房多重耐藥菌的感染類型、耐藥機制、耐藥性及感染相關因素分析. 吉林醫學, 2019, 40(9): 2077-2078.
28.	邰媛媛. 基于隨機森林的ICU患者多重耐藥菌感染預測模型的研究. 湖州師范學院, 2022.
29.	El M A, Zahlane K, Ait S L, et al. The clinical and epidemiological risk factors of infections due to multi-drug resistant bacteria in an adult intensive care unit of University Hospital Center in Marrakesh-Morocco. J Infect Public Health, 2020, 13(4): 637-643.
30.	Magira E E, Islam S, Niederman M S. Multi-drug resistant organism infections in a medical ICU: Association to clinical features and impact upon outcome. Med Intensiva (Engl Ed), 2018, 42(4): 225-234.
31.	Sonti R, Conroy M E, Welt E M, et al. Modeling risk for developing drug resistant bacterial infections in an MDR-naive critically ill population. Ther Adv Infect Dis, 2017, 4(4): 95-103.
32.	桑玉還, 嚴忠婷, 袁媛, 等. 重癥監護病房患者多重耐藥菌感染風險預測模型的系統評價. 中國感染控制雜志, 2023, 22(4): 442-450.
33.	章琦, 李寶珍, 鄭雪梅, 等. 2000—2020年中國多重耐藥菌研究熱點的可視化分析. 中國全科醫學, 2022, 25(24): 2960-2964.
34.	陳春江, 羅悅, 卓文玉, 等. 新生兒重癥監護病房患兒多重耐藥肺炎克雷伯菌耐藥情況及危險因素分析. 兒科藥學雜志, 2024, 30(3): 28-32.
35.	單榮芳, 姜萍, 嚴紅燕, 等. 神經外科ICU患者多重耐藥菌感染危險因素及其與TLR4基因多態性的關聯. 中華醫院感染學雜志, 2023, 33(13): 1981-1985.
36.	木尼熱·艾尼瓦爾, 倪嵐, 程真順, 等. 呼吸重癥監護室肺部多重耐藥菌的危險因素. 武漢大學學報(醫學版), 2024, 45(01): 99-103.
37.	Luo H, Chen X, Jiang Z, et al. Prevalence of and risk factors for intestinal colonisation by multidrug-resistant Gram-negative bacteria in patients with haematological malignancies: A systematic review and meta-analysis. Int J Antimicrob Agents, 2024, 63(1): 107043.
38.	鄒倩, 耿苗苗, 祝延紅. 基于循證理論構建重癥監護病房患者多重耐藥菌感染風險預測模型及外部驗證研究. 中國全科醫學, 2022, 25(12): 1441-1448.
39.	Liberati A, Altman D G, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med, 2009, 6(7): e1000100.
40.	Magiorakos A P, Srinivasan A, Carey R B, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect, 2012, 18(3): 268-281.
41.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
42.	Cumpston M, Li T, Page M J, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, 10(10): D142.
43.	謝朝云, 蒙桂鸞, 覃家露, 等. 中心靜脈導管相關性血流多重耐藥菌感染危險因素分析. 中國消毒學雜志, 2018, 35(12): 919-921.
44.	張湘湘, 陳坤影, 洪寒萍, 等. 綜合干預措施對綜合ICU患者導尿管相關尿路感染的影響. 中國衛生標準管理, 2021, 12(11): 122-125.
45.	國家衛生健康委員會. 中國抗菌藥物管理和細菌耐藥[EB/OL]. [2024-07-09].

1. 衛生部辦公廳關于印發《多重耐藥菌醫院感染預防與控制技術指南(試行)》的通知. 中華人民共和國衛生部公報, 2011, (2): 59-61.
2. 李文進, 耿苗苗, 楊富, 等. 重癥監護室患者多重耐藥菌醫院感染風險因素管理. 中國衛生資源, 2021, 24(5): 560-564.
3. Zhou Y, Yu F, Yu Y, et al. Clinical significance of MDRO screening and infection risk factor analysis in the ICU. Am J Transl Res, 2021, 13(4): 3717-3723.
4. Masse J, Elkalioubie A, Blazejewski C, et al. Colonization pressure as a risk factor of ICU-acquired multidrug resistant bacteria: a prospective observational study. Eur J Clin Microbiol Infect Dis, 2017, 36(5): 797-805.
5. 季亞玲, 王一, 吳蘇春, 等. ICU住院患者多藥耐藥菌感染病原菌耐藥性與免疫功能分析. 中華醫院感染學雜志, 2018, 28(12): 1779-1782.
6. Vincent JL, Sakr Y, Singer M, et al. Prevalence and outcomes of infection among patients in intensive care units in 2017. JAMA, 2020, 323(15): 1478-1487.
7. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet, 2022, 399(10325): 629-655.
8. 王丹, 朱丹, 夏敏, 等. 預防綜合ICU多重耐藥菌醫院感染的成本效益分析. 中國感染控制雜志, 2021, 20(12): 1119-1125.
9. 國家衛生健康委等13部門聯合印發《遏制微生物耐藥國家行動計劃(2022-2025年)》[EB/OL]. [2024-07-09].
10. Wang Y, Wang G, Zhao Y, et al. A deep learning model for predicting multidrug-resistant organism infection in critically ill patients. J Intensive Care, 2023, 11(1): 49.
11. 周芳, 董亞琳. ICU多重耐藥菌醫院感染的危險因素分析. 中國藥房, 2017, 28(14): 1916-1920.
12. 黃文婷, 吳培玉, 黃慧雅, 等. ICU患者多藥耐藥菌感染的影響因素分析. 中華醫院感染學雜志, 2019, 29(21): 3246-3250.
13. 封占輝, 程艷艷, 張汝敏. ICU患者多重耐藥菌感染的相關影響因素分析. 飲食保健, 2020, 7(10): 18-19.
14. 王瑩, 孫春梅, 賈云華. ICU患者多重耐藥菌感染及危險因素分析. 醫院管理論壇, 2021, 38(10): 45-47, 83.
15. Han Y, Zhang J, Zhang H Z, et al. Multidrug-resistant organisms in intensive care units and logistic analysis of risk factors. World J Clin Cases, 2022, 10(6): 1795-1805.
16. Wu C, Lu J, Ruan L, et al. Tracking epidemiological characteristics and risk factors of multi-drug resistant bacteria in intensive care units. Infect Drug Resist, 2023, 16: 1499-1509.
17. 閆荔. 對導致ICU的患者發生多重耐藥菌感染的影響因素分析. 當代醫藥論叢, 2019, 17(22): 57-58.
18. 池偉文, 李翠玲, 田文龍. 梅縣地區重癥監護病房多重耐藥菌感染現狀分析. 山東第一醫科大學(山東省醫學科學院)學報, 2022, 43(10): 765-769.
19. 閻田園, 梁海峰, 王書會, 等. 某醫院ICU住院患者耐藥菌感染危險因素分析. 中國消毒學雜志, 2018, 35(2): 114-117.
20. 虞信維. 某院ICU患者感染多重耐藥菌危險因素分析. 中國衛生檢驗雜志, 2020, 30(22): 2799-2801.
21. 項彥斌, 周燕, 杜建成, 等. 重癥患者多重耐藥菌感染的影響因素及預測模型分析. 重慶醫學, 2020, 49(23): 3966-3970.
22. 劉陽. 重癥監護病房多重耐藥菌感染現狀及預警模型構建--以甘肅省某三甲醫院為例. 蘭州大學公共衛生, 2022.
23. 李嬌, 商臨萍, 郭紅菊, 等. 綜合ICU多重耐藥菌醫院感染的風險模型構建. 中國感染控制雜志, 2016, 15(10): 730-734.
24. 丁夢媛, 李文進, 耿苗苗, 等. 綜合重癥監護病房患者多重耐藥菌醫院感染風險評估模型構建. 中國衛生資源, 2020, 23(4): 384-387,399.
25. 李孝雪, 耿苗苗, 祝延紅. 綜合重癥監護室住院患者多重耐藥菌的臨床分布特點及感染危險因素分析. 中國消毒學雜志, 2024, 41(2): 128-132.
26. 陳慧蘭, 游秋萍, 孫萍. ICU多重耐藥菌感染的護理防控要點與傳播的預警模式構建. 醫學食療與健康, 2021, 19(11): 96-97.
27. 王艷紅, 劉艷紅. 重癥監護病房多重耐藥菌的感染類型、耐藥機制、耐藥性及感染相關因素分析. 吉林醫學, 2019, 40(9): 2077-2078.
28. 邰媛媛. 基于隨機森林的ICU患者多重耐藥菌感染預測模型的研究. 湖州師范學院, 2022.
29. El M A, Zahlane K, Ait S L, et al. The clinical and epidemiological risk factors of infections due to multi-drug resistant bacteria in an adult intensive care unit of University Hospital Center in Marrakesh-Morocco. J Infect Public Health, 2020, 13(4): 637-643.
30. Magira E E, Islam S, Niederman M S. Multi-drug resistant organism infections in a medical ICU: Association to clinical features and impact upon outcome. Med Intensiva (Engl Ed), 2018, 42(4): 225-234.
31. Sonti R, Conroy M E, Welt E M, et al. Modeling risk for developing drug resistant bacterial infections in an MDR-naive critically ill population. Ther Adv Infect Dis, 2017, 4(4): 95-103.
32. 桑玉還, 嚴忠婷, 袁媛, 等. 重癥監護病房患者多重耐藥菌感染風險預測模型的系統評價. 中國感染控制雜志, 2023, 22(4): 442-450.
33. 章琦, 李寶珍, 鄭雪梅, 等. 2000—2020年中國多重耐藥菌研究熱點的可視化分析. 中國全科醫學, 2022, 25(24): 2960-2964.
34. 陳春江, 羅悅, 卓文玉, 等. 新生兒重癥監護病房患兒多重耐藥肺炎克雷伯菌耐藥情況及危險因素分析. 兒科藥學雜志, 2024, 30(3): 28-32.
35. 單榮芳, 姜萍, 嚴紅燕, 等. 神經外科ICU患者多重耐藥菌感染危險因素及其與TLR4基因多態性的關聯. 中華醫院感染學雜志, 2023, 33(13): 1981-1985.
36. 木尼熱·艾尼瓦爾, 倪嵐, 程真順, 等. 呼吸重癥監護室肺部多重耐藥菌的危險因素. 武漢大學學報(醫學版), 2024, 45(01): 99-103.
37. Luo H, Chen X, Jiang Z, et al. Prevalence of and risk factors for intestinal colonisation by multidrug-resistant Gram-negative bacteria in patients with haematological malignancies: A systematic review and meta-analysis. Int J Antimicrob Agents, 2024, 63(1): 107043.
38. 鄒倩, 耿苗苗, 祝延紅. 基于循證理論構建重癥監護病房患者多重耐藥菌感染風險預測模型及外部驗證研究. 中國全科醫學, 2022, 25(12): 1441-1448.
39. Liberati A, Altman D G, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med, 2009, 6(7): e1000100.
40. Magiorakos A P, Srinivasan A, Carey R B, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect, 2012, 18(3): 268-281.
41. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
42. Cumpston M, Li T, Page M J, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, 10(10): D142.
43. 謝朝云, 蒙桂鸞, 覃家露, 等. 中心靜脈導管相關性血流多重耐藥菌感染危險因素分析. 中國消毒學雜志, 2018, 35(12): 919-921.
44. 張湘湘, 陳坤影, 洪寒萍, 等. 綜合干預措施對綜合ICU患者導尿管相關尿路感染的影響. 中國衛生標準管理, 2021, 12(11): 122-125.
45. 國家衛生健康委員會. 中國抗菌藥物管理和細菌耐藥[EB/OL]. [2024-07-09].

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Meta-analysis on risk factors for multidrug-resistant organism infections in general ICU patients

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