Background. Multidrug-resistant (MDR) bacteria are the main cause of lower respiratory tract infections (LRTIs) with high mortality. The purpose of this study is to identify the risk factors associated with MDR by performing a systematic review and meta-analysis. Methods. PubMed, EMBASE (via Ovid), and Cochrane Library were systematically searched for studies on the risk factors for MDR bacteria in LRTIs as of November 30, 2019. Literature screening, data abstraction, and quality assessment of the eligible studies were performed independently by two researchers. Results. A total of 3,607 articles were retrieved, of which 21 articles representing 20 cohort studies published in English were included after title/abstract and full-text screening. Among the 21 articles involving 7,650 patients and 1,360 MDR organisms, ten reported the risk factors for MDR Gram-positive bacteria (GPB) and Gram-negative bacteria (GNB), ten for MDR GNB, and one for MDR GPB. The meta-analysis results suggested that prior antibiotic treatment, inappropriate antibiotic therapy, chronic lung disease, chronic liver disease and cerebral disease, prior MDR and PA infection/colonization, recent hospitalization, longer hospitalization stay, endotracheal tracheostomy and mechanical ventilation, tube feeding, nursing home residence, and higher disease severity score were independent risk factors for MDR bacteria. Conclusions. This review identified fourteen clinical factors that might increase the risk of MDR bacteria in patients with LRTIs. Clinicians could take into account these factors when selecting antibiotics for patients and determine whether coverage for MDR bacteria is required. More well-designed studies are needed to confirm the various risk factors for MDR bacteria in the future.

中文翻译：

---

下呼吸道感染中多重耐药菌的危险因素：系统评价和荟萃分析。

背景。耐多药（MDR）细菌是下呼吸道感染（LRTIs）的主要原因，死亡率很高。本研究的目的是通过进行系统回顾和荟萃分析来确定与 MDR 相关的风险因素。方法。截至 2019 年 11 月 30 日，系统检索了 PubMed、EMBASE（通过 Ovid）和 Cochrane Library，以查找有关 LRTI 中耐多药细菌风险因素的研究。符合条件的研究的文献筛选、数据提取和质量评估由两名独立进行研究人员。结果. 共检索到 3,607 篇文章，其中 21 篇代表 20 个以英文发表的队列研究在标题/摘要和全文筛选后被纳入。在涉及 7,650 名患者和 1,360 种耐多药微生物的 21 篇文章中，10 篇报告了耐多药革兰氏阳性菌 (GPB) 和革兰氏阴性菌 (GNB) 的危险因素，10 篇报告了耐多药 GNB，1 篇报告了耐多药 GPB。荟萃分析结果表明，既往抗生素治疗、不适当抗生素治疗、慢性肺病、慢性肝病和脑病、既往 MDR 和 PA 感染/定植、近期住院、住院时间较长、气管内气管切开术和机械通气、管饲、疗养院居住和较高的疾病严重程度评分是 MDR 细菌的独立危险因素。结论。本综述确定了 14 种可能增加 LRTI 患者感染 MDR 细菌风险的临床因素。临床医生在为患者选择抗生素时可以考虑这些因素，并确定是否需要覆盖 MDR 细菌。未来需要更多精心设计的研究来确认 MDR 细菌的各种危险因素。