ATP生物荧光测定法检测软式内镜清洗消毒效果的meta分析

Evaluation of ATP bioluminescence technology for cleaning and disinfection of flexible endoscopes: a meta‑analysis

摘要:

目的 系统评价ATP生物荧光测定法与传统微生物学监测法检测软式内镜清洗消毒效果的能力。方法 检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方数据库、维普数据库及中国生物医学文献数据库8个中英文数据库，检索时间为自建库至2023年10月1日，筛选ATP生物荧光测定法与传统微生物学监测法对软式内镜清洗消毒后质量评价效果的对比研究，以两种方法检测出的阳性样本数量及阳性率为主要效应指标，使用固定效应模型对所纳入的文献进行meta分析。结果 共纳入中英文文献14篇，4 569例样本，涉及的器械包括胃镜、结肠镜、十二指肠镜及纤维支气管镜。研究间同质性较好（I2=23%），合并OR=1.57（95%CI：1.27~1.94），2种检测方法的阳性率差异有统计学意义（P<0.001）。漏斗图提示可能存在发表偏倚。结论 ATP生物荧光测定法与微生物学监测法所得到的监测结果具有相关性，ATP生物荧光测定法在一定程度上可以反映内镜清洗消毒后的清洁程度，虽检测速度较快、时效性较好，但所测得样本阳性率明显高于微生物学监测法，尚无法取代传统的微生物学监测法。

Abstract:

Objective To systematically evaluate the efficacy of ATP bioluminescence technology versus traditional microbiology detection method in assessing flexible endoscope cleaning and disinfection. Methods Eight Chinese and English databases, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Database, VIP Chinese Medical Journal Database and China Biology Medicine disc, were searched from inception to October 1, 2023. Comparative studies on evaluating post-reprocessing endoscope quality using both methods were included. Positive sample numbers and positive rates were taken as the main effect indicators, and the fixed effect model was used to conduct a meta-analysis of the included literature. Results A total of 14 Chinese and English articles were included, involving 4 569 samples (gastroscopes, colonoscopes, duodenoscopes and fiberbronchoscopes). The pooled analysis demonstrated low heterogeneity across studies (I²=23%), with a combined odds ratio (OR) of 1.57 (95%CI: 1.27-1.94). It indicated a statistically significant difference in positive detection rates between the two methods (P<0.001). However, funnel plot analysis suggested potential publication bias. Conclusion ATP bioluminescence correlates with microbiological methods for monitoring endoscope reprocessing. While ATP offers rapid assessment advantages, its consistently higher positive rates preclude replacement of conventional microbiological verification for terminal disinfection.