基于中国背景的细菌耐药所致健康和经济负担的系统评价

周越 杨瑶瑶 张翕 胡琳 杜可欣 郑波 管晓东 海沙尔江·吾守尔 史录文

編者按：为深入学习贯彻习近平新时代中国特色社会主义思想，落实2021年全国宣传部长会议和全国卫生健康工作会议精神，聚焦中国共产党成立以来卫生健康事业历史进程中的重要决策、活动及成果，从不同角度和层面展现卫生健康事业发展的重要成就，我刊特从2021年7月起开设“党为人民谋健康的100年”专栏，从我刊实际出发，陆续推出一系列我国健康卫生事业与药学工作结合的相关文章，从而助力提高人民健康水平制度保障、坚持和发展中国特色卫生健康制度。本期专栏文章《基于中国背景的细菌耐药所致健康和经济负担的系统评价》在细菌耐药持续发展的背景下，通过收集文献对我国细菌耐药的健康和经济负担情况、测算方法以及研究质量进行汇总、分析，以期为我国细菌耐药负担的测算研究提供科学依据，为国家遏制细菌耐药的政策制定提供参考。

中图分类号 R956;R969.3 文献标志码 A 文章编号 1001-0408（2021）20-2543-08

DOI 10.6039/j.issn.1001-0408.2021.20.18

摘 要 目的：为我国细菌耐药所致负担的测算研究提供科学依据，为国家遏制细菌耐药的政策制定提供参考。方法：计算机检索中国知网、万方数据、维普网、PubMed、Scopus、Medline和EconoLite等数据库，收集基于中国背景的细菌耐药负担的相关研究，检索文献的发表时间为2016年1月1日-2020年8月10日。经独立筛选文献、提取资料后，采用Newcastle-Ottawa（NOS）量表进行文献质量评价，对细菌耐药造成的健康和经济负担进行描述性分析。结果：共纳入中英文文献27篇。纳入文献的NOS评分为4～6分，均采用回顾性病例对照设计，将患者分为病例组（耐药菌感染）和对照组（敏感菌感染或无感染），研究常用测算指标包括死亡率、住院时长和诊治费用。纳入的研究中，耐药菌感染者的死亡率是敏感菌感染者的0.7～12.0倍，其总住院时长的平均值或中位数是敏感菌感染者的0.9～2.5倍，其总诊治费用的平均值或中位数是敏感菌感染者的1.0～2.7倍。上述指标在耐药菌感染者和无感染者之间的差异更大。结论：细菌耐药会增加患者的健康和经济负担。但现有相关文献质量中等，以单中心研究为主，样本代表性不足，研究设计未考虑时间依赖性偏倚且可重复性低，研究指标较单一，测算范围较局限，亟需开展更高质量、多中心的实证调查以全面测算我国细菌耐药所致的健康和经济负担。

关键词 细菌耐药;健康负担;经济负担;文献;系统评价;中国

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.