预防性使用抗菌药物预防急性脑卒中后感染有效性的Meta分析
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篇名: 预防性使用抗菌药物预防急性脑卒中后感染有效性的Meta分析
TITLE: Effectiveness of Prophylactic Use of Antibiotics for Preventing Infection after Acute Stroke :A Meta-analysis
摘要: 目的:系统评价预防性使用抗菌药物预防急性脑卒后感染的有效性,为急性脑卒中后感染的预防提供循证参考。方法:计算机检索PubMed、Embase、Cochrane图书馆、中国期刊全文数据库、中文科技期刊数据库、万方数据库以及Central等临床试验注册平台,检索时限为各数据库建库或平台自建立起至2019年12月。收集预防性使用抗菌药物(试验组)对比安慰剂或未预防性使用抗菌药物(对照组)预防急性脑卒中后感染有效性的随机对照试验(RCT),对符合纳入标准的文献进行资料提取后,采用Co-chrane偏倚风险评估工具5.1.0和改良的Jadad量表进行文献质量评价,采用RevMan5.3统计软件进行Meta分析,并采用GRADE系统对Meta分析结果进行分析。结果:共纳入7项RCT,合计4310例患者。Meta分析结果显示,两组患者病死率[RR=1.05,95%CI(0.92,1.20),P=0.47]、肺炎发生率[RR=0.92,95%CI(0.77,1.11),P=0.40]比较,差异均无统计学意义。试验组患者总感染率[RR=0.69,95%CI(0.57,0.85),P=0.0003]、尿路感染发生率[RR=0.38,95%CI(0.29,0.49),P<0.00001]均显著低于对照组,差异均有统计学意义。GRADE评价显示各结局指标等级均为高质量。结论:预防性使用抗菌药物可降低急性脑卒中后总感染率和尿路感染发生率,但不能显著影响病死率和肺炎发生率。
ABSTRACT: OBJECTIVE:To systematically evaluate the effectiveness of prophylactic use of antibiotics for infection after acute stroke,and to provide evidence-based reference for clinical treatment for infection after acute stroke. METHODS :Retrieved from PubMed,Embase,Cochrane library ,CJFD,VIP,Wanfang database and trial registration platforms such as Central ,randomized controlled trials (RCTs)about the effectiveness of prophylactic use of antibiotics (trial group )versus placebo or non-prophylactic use of antibiotics (control group )in the prevention of infection after acute stroke were collected during the inception to Dec. 2019. After data extraction ,the quality of included literatures were evaluated with Cochrane bias risk assessment tool 5.1.0 and modified Jadad scale. Meta-analysis was carried out by using Rev Man 5.3 statistical software. GRADE system was used to analysis the result of Meta-analysis. RESULTS :A total of 7 RCTs were included ,involving 4 310 patients. The results of Meta-analysis showed that there was no statistical significance in the mortality of patients [RR =1.05,95%CI(0.92,1.20),P=0.47] or the incidence of pneumonia [RR =0.92,95%CI(0.77,1.11),P=0.40] between 2 groups. The total infection rate [RR =0.69,95%CI(0.57, 0.85),P=0.000 3] and the incidence of urinary tract infection [RR =0.38,95%CI(0.29,0.49),P<0.000 01] in the trial group were significantly lower than control group ,and the difference was statistically significant. Result of GRADE showed the out- comes were in high-quality grade. CONCLUSIONS :Prophylactic use of antibiotics can reduce the total infection rate and the incidence of urinary tract infection after acute stroke ,but can not significantly affect the mortality and the incidence of pneumonia.
期刊: 2020年第31卷第13期
作者: 柯义君,王威,金涌,居靖
AUTHORS: KE Yijun,WANG Wei,JIN Yong,JU Jing
关键字: 抗菌药物;预防性使用;有效性;急性脑卒中;感染;肺炎;尿路感染;Meta分析
KEYWORDS: Antibiotics;Prophylactic use ;Effectiveness;Acute stroke ;Infection;Pneumonia;Urinary tract infection ;
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