Meta-analysis Of Characteristics And Risk Factors Of Secondary Invasive Fungal Infection After Trauma

OBJECTIVE:To use Meta-analysis to comprehensively evaluate the characteristics of invasive fungal infections,high-risk factors of infection,and prevention and treatment strategies after trauma,and provide evidence-based medical evidence for the treatment of invasive fungal infections during trauma treatment.Methods: Searching the library’s domestic and foreign databases through computer,searching CBM,CNKI,Wanfang Database,China Database China Database;Pubmed,SCI,OVID,Embase,etc.English databases,collecting relevant literature on post-traumatic invasive fungal infections,search key Words include Chinese and English.Select the documents that meet the inclusion criteria,then use the Storbe statement to evaluate the quality of the included studies,and use RevMan5.3 and Stata11.0 software for meta-analysis to extract data.RESULTS: Eight patients were included in the final assessment-a randomized controlled trial,including 4 in Chinese and 4 in English;6,106 inpatients with trauma,and 772 subsequent invasive fungal infections after trauma.Storbe stated that the evaluation included the overall quality of the literature.Meta-analysis showed that772 cases were included in the total infection site,and the constituent ratios were respiratory tract(36%),digestive tract(26%),urinary tract(21%),blood(13%),wound(7%),eye(6%)intracranial(4%);single site 80%,20% more than two sites;inclusion of fungal infection 772 cases,the composition ratio of Candida(52%),Yeast(37%)Cryptococcus(17%),Aspergillus(15%),Pneumocystis(10%)and Mucormycetes(7%);mixed infection of the two fungi was 17%;452 cases were included in the combined bacterial infection,and the composition ratio wasStaphylococcus aureus(42%),Escherichia coli(27%),Pseudomonas aeruginosa(16%),Enterococcus(17%);mixed infection of 2 bacteria was 20% of invasive fungal infections in 772 cases,The composition ratio was fever(42%),neutrophils(27%),leukocytosis(16%),tissue necrosis(17%),organ damage(17%),and disturbance of consciousness(8%).Incorporation of 772 bacterial infections,the composition ratio of surgical debridement(93%),antifungal drugs(96%),amphotericin-B(36%),fluconazole(30%),itraconazole(13%),ketoconazole(15%),caspofungin(8%),5-fluorocytosine(3%),miconazole(8%);28% of the fungi were used in combination with two antifungal drugs.The deaths of patients with secondary invasive fungal infections after trauma were higher than those of non-infected control patients with traumatic secondary invasive fungal infections.This indicates that invasive fungal infections increase the risk of death in trauma patients;invasive fungal infections after trauma There was no significant difference between the patient’s gender(male)and the control group(P> 0.05);meta-analysis showed that the two groups of trauma patients were> 60 years old,long-term antibiotic use> 2 weeks,underlying disease,use of glucocorticoids,intravenous administration There were significant differences between high-nutrition,invasive operation,mechanical ventilation,ICU admission,and severe trauma constituent ratios(P <0.05),which were significantly different from those in the control group.Egger and Begg and funnel plots.Analysis of the distribution of scattered points on both sides of the basic symmetrical distribution(P>0.05).Conclusions: The main sites of secondary invasive fungal infection after trauma are respiratory tract and urinary tract.Single site infection,intracranial infection,wound infection and multi-site infection also require attention.The main pathogens are Candida,yeast,Cryptococcus and Aspergillus,lungs.Mixed infection of spores,mucor and two kinds of invasive fungi also needs attention;secondary fungal infections and bacterial infections after trauma are mainly Staphylococcus aureus,Escherichia coli,Pseudomonas and Enterococcus,invasive fungal infection after trauma Bacterial infections need attention;most have symptoms of infection,including fever,leukocytosis and neutrophils,local soft tissue necrosis is the mostcommon signs,some serious patients with organ damage and disturbance of consciousness;treatment methods,mainly Surgical debridement and antifungal medications are the main methods.Amphotericin-B and fluconazole are the main drugs,and anti-fungus drugs are administered in combination when necessary.Invasive fungal infections after trauma increase the risk of death in trauma patients.Gender composition ratio has no significant effect on post-traumatic invasive fungal infections;age greater than 60 years,with greater than 2 After,underlying diseases,intravenous nutrition,invasive procedures,mechanical ventilation,stay ICU,the severity of the trauma secondary to trauma increases the risk of invasive fungal infections.The eight studies included had baseline comparability,but there were varying degrees of bias.