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目的对国内外长期使用抗生素预防儿童反复泌尿道感染(UTI)的研究进行Meta分析,评价长期使用抗生素预防儿童反复UTI的疗效和安全性。方法制定原始文献的纳入标准、排除标准及检索策略,检索PubMed、EMBASE、Ovid、Springer和中国期刊全文数据库、万方数据资源系统等,获得长期使用抗生素预防儿童反复UTI的研究文献。使用国际Cochrane中心推荐的方法进行文献质量评价,采用RevMan 5.2软件对满足纳入标准的文献进行Meta分析。选取反复发生有症状的UTI的例数、反复尿培养阳性的例数、不良反应以及对抗生素的耐药性作为观察指标,得出合并后的风险比(RR)及其95%可信区间(CI)进行定量综合评估。结果共检索出455篇文献,符合纳入标准的5篇随机对照研究进入Meta分析,纳入研究的偏倚风险较小,研究间存在异质性。Meta分析结果显示,与安慰剂或不干预比较,长期使用抗生素不减少反复症状性UTI的发生(RR=0.75,95%CI:0.36~1.53,P=0.43),不减少反复尿培养阳性的发生(RR=0.31,95%CI:0.08~1.18,P=0.08),不增加不良反应的发生(RR=2.31,95%CI:0.03~170.67,P=0.70),增加对抗生素耐药的发生(RR=2.13,95%CI:1.05~4.31,P=0.04)。结论长期使用抗生素预防不减少儿童反复UTI的发生,并增加对抗生素的耐药。
Objective To analyze the long-term use of antibiotics to prevent recurrent urinary tract infections (UTI) in children both at home and abroad and evaluate the efficacy and safety of long-term use of antibiotics to prevent recurrent UTI in children. Methods To establish the inclusion criteria, exclusion criteria and search strategies of original documents, and to search PubMed, EMBASE, Ovid, Springer and Chinese Journal Full-text Database, Wanfang Data Resource System and so on, to obtain the research literature on long-term use of antibiotics to prevent recurrent UTI in children. Literature quality was evaluated using the methods recommended by the International Cochrane Center, and Meta-analysis was performed using RevMan 5.2 software to meet the inclusion criteria. The number of recurrent UTIs, the number of recurrent urinary cultures, adverse reactions, and antibiotic resistance were used as the indicators of observation to determine the combined risk ratio (RR) and its 95% confidence interval CI) for quantitative comprehensive assessment. Results A total of 455 articles were retrieved. Five randomized controlled trials that met the inclusion criteria were included in the meta-analysis. The risk of bias in the included trials was low and there was heterogeneity among the studies. Meta-analysis showed that prolonged use of antibiotics did not reduce the incidence of recurrent symptomatic UTI (RR = 0.75, 95% CI: 0.36 to 1.53, P = 0.43) compared with placebo or no intervention, without diminishing the occurrence of recurrent urine culture (RR = 0.31, 95% CI: 0.08-1.18, P = 0.08), did not increase the incidence of adverse reactions (RR = 2.31,95% CI: 0.03-170.67, P = 0.70) RR = 2.13, 95% CI: 1.05-4.31, P = 0.04). Conclusion Long-term use of antibiotic prophylaxis does not reduce the occurrence of recurrent UTI in children and increase the resistance to antibiotics.