Incidence, temporal trend and factors associated with ventilator-associated pneumonia in mainland China: a systematic review and meta-analysis.
Incidence, temporal trend and factors associated with ventilator-associated pneumonia in mainland China: a systematic review and meta-analysis.
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DOI：
10.1186/s12879-017-2566-7
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发表时间：
2017-07-04
影响因子：
3.7
通讯作者：
Zhan S
中科院分区：
文献类型：
--
作者：
Ding C;Zhang Y;Yang Z;Wang J;Jin A;Wang W;Chen R;Zhan S
迄今为止的数据远远不足以描述最近大陆中国呼吸机相关肺炎的流行病学。这项研究旨在估计VAP的总体发病率，并特别关注其时间趋势和相关因素。对2010年至2015年发表的195项研究进行了Meta分析，然后按方法质量、预先定义的背景特征和人口属性进行了亚组分析。大陆中国的VAP总累积发病率为23.8%(95%可信区间为20.6-27.2%)，结果显示高度异质性。合并发病密度为24.14次(95%可信区间21.19~27.51)和22.83(95%可信区间19.88~26.23)患者/1000天。从2006年(49.5%，95%可信区间40.0-59.0%)到2014年(19.6%，95%可信区间10.4-31.0%)，累积发病率呈下降趋势；根据中国各省和诊断标准(P<0.001)，发病率也存在差异。年龄较大(≥60岁)、昏迷、再次插管、气管切开和机械通气时间延长是发生呼吸机相关性肺炎的显著因素。在大陆中国，呼吸机相关性肺炎的发病率仍然很高，但自2006年以来有所下降。报告的发病率在不同的研究中差异很大，可能是由于诊断和地理区域的差异。需要更多使用标准定义和截断点的研究，以更好地澄清全国范围内VAP的流行病学。本文的在线版本(doi：10.1186/s12879-0172566-7)包含补充材料，授权用户可以使用。
Data to date is far from sufficient to describe the recent epidemiology of ventilator-associated pneumonia (VAP) in mainland China. This study aimed to estimate the overall incidence of VAP, with a special focus on its temporal trend and associated factors. Meta-analyses of 195 studies published from 2010 to 2015 were conducted, followed by subgroup analyses by methodological quality, pre-defined setting characteristics and attributes of populations. The overall cumulative VAP incidence in mainland China was 23.8% (95% confidence interval (CI) 20.6–27.2%), with the results showing high heterogeneity. The pooled incidence densities were 24.14 (95% CI 21.19–27.51) episodes and 22.83 (95% CI 19.88–26.23) patients per 1000 ventilator-days. A decline in the cumulative incidence was observed from 2006 (49.5%, 95% CI 40.0–59.0%) to 2014 (19.6%, 95% CI 10.4–31.0%); differences in the incidence rates were also documented according to Chinese provinces and diagnostic criteria (p < 0.001). Older age (≥60 years), coma, re-intubation, tracheotomy and prolonged ventilation were the factors significantly associated with the occurrence of VAP. The incidence of VAP remains high in mainland China but has decreased since 2006. The reported rates vary considerably across individual studies, probably due to variations in diagnosis and geographical region. More studies using standard definitions and cut-off points are needed to better clarify the epidemiology of VAP across the country. The online version of this article (doi:10.1186/s12879-017-2566-7) contains supplementary material, which is available to authorized users.