[1]杜霈,秦瑾,冯忠军,等.MRSA鼻腔筛查可排除MRSA手术部位感染:一项诊断实验meta分析[J].中华老年骨科与康复电子杂志,2020,(03):171-177.[doi:10.3877/cma.j.issn.2096-0263.2020.03.009]
 Du Pei,Qin Jin,Feng Zhongjun,et al.MRSA nasal screening to rule out MRSA surgical site infection:a diagnostic meta-analysis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2020,(03):171-177.[doi:10.3877/cma.j.issn.2096-0263.2020.03.009]
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MRSA鼻腔筛查可排除MRSA手术部位感染:一项诊断实验meta分析()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2020年03期
页码:
171-177
栏目:
Meta分析
出版日期:
2020-06-05

文章信息/Info

Title:
MRSA nasal screening to rule out MRSA surgical site infection:a diagnostic meta-analysis
作者:
杜霈1秦瑾2冯忠军1郑翠影3高伟1宋珮瑶1刘一冰1
050051 石家庄,河北医科大学第三医院感控科1;河北省骨科疾病临床医学研究中心2;河北医科大学第三医院细菌室3
Author(s):
Du Pei1 Qin Jin2 Feng Zhongjun1 Zheng Cuiying3 Gao Wei1 Song Peiyao1 Liu Yibing1.
1Department of Infection Control and Prevention, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China; 2Department of Orthopaedic Clinical Research Center, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China; 3 Department of Bacteriology, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
关键词:
手术部位感染 耐甲氧西林金黄色葡萄球菌 鼻腔筛查 meta分析
Keywords:
Surgical site infection Methicillin resistant staphylococcus aureus Nasal screening Meta-analysis
DOI:
10.3877/cma.j.issn.2096-0263.2020.03.009
文献标志码:
A
摘要:
目的 评价耐甲氧西林金黄色葡萄球菌(MRSA)鼻腔筛查对于MRSA手术部位感染的诊断价值。方法 检索PubMed、EMBASE、中国知网和万方数据库中,有关MRSA鼻腔筛查与MRSA手术部位感染的文献。纳入文献时间从数据库建立到2019年3月。使用诊断实验质量评价表(QUADAS-2)进行质量评价。采用STATA软件进行分析,结局指标为灵敏度、特异度、阳性似然比、阴性似然比、阳性预测值和阴性预测值。结果 最终纳入10篇文献,共39 831名患者。MRSA鼻腔筛查对于诊断及预测MRSA手术部位感染的灵敏度为37% (95% CI:27%,48%)、特异度为95%(95% CI:94%,96%)。阳性似然比为7.98(95% CI:6.37,10.0),阴性似然比为0.66(95% CI:0.57,0.77),阳性预测值为9.6%,阴性预测值为99.3%,DOR为12.0(95% CI:8.62,16.8)。异质性来源于MRSA筛查时使用的鉴定方法(PCR法/细菌培养法)。Deeks漏斗图显示,纳入研究不存在发表偏倚。结论 MRSA鼻腔筛查对于筛查MRSA手术部位感染具有较高的特异度和阴性预测值,可用于排除MRSA肺炎,患者鼻腔未定植MRSA,则发展为MRSA手术部位感染的可能性较小。所以,MRSA鼻腔筛查可作为规范抗菌药物经验性用药的一种有效管理工具,尤其可用于减少无鼻腔定植者的经验性治疗。
Abstract:
Objective To evaluate the diagnostic value of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening in MRSA surgical site infection (SSI). Methods PubMed, EMBASE CNKI and WANFANG DATA were searched for studies evaluating MRSA nasal screening and development of MRSA SSI. The time of inclusion was from the establishment of the database to March 2019. Quality evaluation was carried out using QUADAS-2. Data analysis was performed using STATA software to estimate pooled sensitivity, specifcity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR), positive predictive value (PPV), and negative predictive value (NPV). Results Ten studies, comprising 39 831 patients, met our inclusion criteria. The pooled sensitivity and specifcity of MRSA nares screen for MRSA SSI were 37% (95% CI: 27%, 48%) and 95% (95% CI: 94%, 96%), respectively. The PLR was 7.98 (95% CI: 6.37,10.0) and the NLR was 0.66 (95% CI: 0.57, 0.77). The PPV was 6.9%, the NPV was 99.3%, and DOR was 12.0 (95% CI: 8.62, 16.8). Heterogeneity arose from the methods used in MRSA screening (PCR/culture). Deeks funnel plot showed that the data and a low probability of publication bias. Conclusions Nares screening for MRSA had a high specificity and NPV for ruling out MRSA SSI. MRSA nares screening is a valuable tool to streamline empiric antibiotic therapy, especially among patients with SSI who are not colonized with MRSA.

参考文献/References:

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备注/Memo

备注/Memo:
河北省医学科学研究课题计划(20201008)
更新日期/Last Update: 2020-07-07