基于中國背景的細菌耐藥所致健康和經(jīng)濟負擔(dān)的系統(tǒng)評價

周越 楊瑤瑤 張翕 胡琳 杜可欣 鄭波 管曉東 海沙爾江·吾守爾 史錄文

編者按：為深入學(xué)習(xí)貫徹習(xí)近平新時代中國特色社會主義思想，落實2021年全國宣傳部長會議和全國衛(wèi)生健康工作會議精神，聚焦中國共產(chǎn)黨成立以來衛(wèi)生健康事業(yè)歷史進程中的重要決策、活動及成果，從不同角度和層面展現(xiàn)衛(wèi)生健康事業(yè)發(fā)展的重要成就，我刊特從2021年7月起開設(shè)“黨為人民謀健康的100年”專欄，從我刊實際出發(fā)，陸續(xù)推出一系列我國健康衛(wèi)生事業(yè)與藥學(xué)工作結(jié)合的相關(guān)文章，從而助力提高人民健康水平制度保障、堅持和發(fā)展中國特色衛(wèi)生健康制度。本期專欄文章《基于中國背景的細菌耐藥所致健康和經(jīng)濟負擔(dān)的系統(tǒng)評價》在細菌耐藥持續(xù)發(fā)展的背景下，通過收集文獻對我國細菌耐藥的健康和經(jīng)濟負擔(dān)情況、測算方法以及研究質(zhì)量進行匯總、分析，以期為我國細菌耐藥負擔(dān)的測算研究提供科學(xué)依據(jù)，為國家遏制細菌耐藥的政策制定提供參考。

中圖分類號 R956;R969.3 文獻標(biāo)志碼 A 文章編號 1001-0408（2021）20-2543-08

DOI 10.6039/j.issn.1001-0408.2021.20.18

摘 要 目的：為我國細菌耐藥所致負擔(dān)的測算研究提供科學(xué)依據(jù)，為國家遏制細菌耐藥的政策制定提供參考。方法：計算機檢索中國知網(wǎng)、萬方數(shù)據(jù)、維普網(wǎng)、PubMed、Scopus、Medline和EconoLite等數(shù)據(jù)庫，收集基于中國背景的細菌耐藥負擔(dān)的相關(guān)研究，檢索文獻的發(fā)表時間為2016年1月1日-2020年8月10日。經(jīng)獨立篩選文獻、提取資料后，采用Newcastle-Ottawa（NOS）量表進行文獻質(zhì)量評價，對細菌耐藥造成的健康和經(jīng)濟負擔(dān)進行描述性分析。結(jié)果：共納入中英文文獻27篇。納入文獻的NOS評分為4～6分，均采用回顧性病例對照設(shè)計，將患者分為病例組（耐藥菌感染）和對照組（敏感菌感染或無感染），研究常用測算指標(biāo)包括死亡率、住院時長和診治費用。納入的研究中，耐藥菌感染者的死亡率是敏感菌感染者的0.7～12.0倍，其總住院時長的平均值或中位數(shù)是敏感菌感染者的0.9～2.5倍，其總診治費用的平均值或中位數(shù)是敏感菌感染者的1.0～2.7倍。上述指標(biāo)在耐藥菌感染者和無感染者之間的差異更大。結(jié)論：細菌耐藥會增加患者的健康和經(jīng)濟負擔(dān)。但現(xiàn)有相關(guān)文獻質(zhì)量中等，以單中心研究為主，樣本代表性不足，研究設(shè)計未考慮時間依賴性偏倚且可重復(fù)性低，研究指標(biāo)較單一，測算范圍較局限，亟需開展更高質(zhì)量、多中心的實證調(diào)查以全面測算我國細菌耐藥所致的健康和經(jīng)濟負擔(dān)。

關(guān)鍵詞 細菌耐藥;健康負擔(dān);經(jīng)濟負擔(dān);文獻;系統(tǒng)評價;中國

Systematic Review of Health and Economic Burden Caused by Antibiotic Resistance in China

ZHOU Yue1，YANG Yaoyao1，ZHANG Xi1，HU Lin1，DU Kexin1，ZHENG Bo2，GUAN Xiaodong1，3， Haishaerjiang WUSHOUER1，3，SHI Luwen1，3（1. Dept. of Pharmacy Administration and Clinical Pharmacy， School of Pharmaceutical Sciences， Peking University， Beijing 100191， China; 2. Institute of Clinical Pharmacology， Peking University， Beijing 100191， China; 3. International Research Center for Medicinal Administration， Peking University， Beijing 100191， China）

ABSTRACT? ?OBJECTIVE： To provide scientific basis for evaluating the burden caused by antibiotic resistance （AbR） and reference for policy making on crubing AbR in China. METHODS： Databases including CNKI， Wanfang database， VIP， PubMed， Scopus， Medline and EconoLite from Jan. 1st 2016 to Aug. 10th 2020 were searched to collect studies on burden caused by AbR in China. After independent literature screening and data extraction， Newcastle-Ottawa scale （NOS） was used to evaluate the literature quality， and a descriptive analysis was conduced to evaluate the health and economic burden caused by AbR. RESULTS： A total of 27 Chinese and English literatures were included. The NOS scores of included literatures were 4-6， and all of them were retrospective case-control study; the patients were divided into case group （resistance infection） and control group （susceptible infection or non-infection）; mortality， length of stay and medical expenditure were commonly applied as the measurement indexes. In the included studies， the mortality of patients infected with AbR bacteria was 0.7-12.0 times that of patients infected with susceptible bacteria; the mean or medium value of total length of stay was 0.9-2.5 times that of patients infected with susceptible bacteria; the mean or medium of total medical expenditure was 1.0-2.7 times that of patients with susceptible bacteria infection. The differences in these indicators were greater between patients infected with AbR infections and those without becterial infections. CONCLUSIONS： Bacterial drug resistance could increase the health and economic burden. However， the existing relevant studies were mainly single center researches， the sample representation was insufficient; the research design did not adjust for time-dependent bias; the repeatability was low， and the perspective of evalution was limited. It is urgent to carry out multicenter studies with higher quality to comprehensively evaluate the health and economic burden caused by AbR in China.