ObjectiveTo systematically review the risk factors of refractory mycoplasma pneumoniae pneumonia (RMPP) in children. MethodsPubMed, The Cochrane Library, EMbase, CNKI, CBM, VIP, and WanFang Data databases were electronically searched for case-control studies and cohort studies on the risk factors of RMPP in children from inception to March 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. ResultsA total of 27 case-control studies involving 3 967 children with RMPP and 11 613 children with common MPP were included. The results of meta-analysis showed that heat course (OR=2.07, 95%CI 1.98 to 2.16, P<0.000 01), length of hospital stay (OR=1.42, 95%CI 1.14 to 1.69, P<0.000 01), recurrent respiratory tract infection (OR=8.51, 95%CI 6.15 to 11.77, P<0.000 01), level of IL-6 (OR=21.95, 95%CI 20.85 to 23.06, P<0.000 01), level of CRP (OR=2.41, 95%CI 1.94 to 2.87, P<0.000 01), level of LDH (OR=0.79, 95%CI 0.53 to 1.06, P<0.000 01), level of ESR (OR=2.65, 95%CI 1.13 to 4.18, P=0.000 6), combined pleural effusion (OR=9.42, 95%CI 3.65 to 24.31, P<0.000 01), combined with extrapulmonary complications (OR=3.33, 95%CI 2.42 to 4.58, P<0.000 01), large lung consolidation (OR=12.31, 95%CI 5.42 to 27.99, P<0.000 01) were the risk factors for RMPP. ConclusionsCurrent evidence indicates that heat course, length of hospital stay, repeated respiratory tract infection, high level of IL-6, high level of CRP, high level of LDH, high level of ESR, combined pleural effusion, combined extrapulmonary complications, and large lung consolidation are risk factors for children with RMPP. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
ObjectiveTo assess the methodological quality of guidelines for bronchoscopic alveolar lavage. MethodsCNKI, VIP, WanFang Data, CBM, Web of Science, PubMed, EMbase databases and medlive.cn, the National Guideline Clearinghouse (NGC), the National Guideline International Network (GIN), the Scottish Intercollegiate Guidelines Network (SIGN), the National Institute for Clinical Excellence (NICE), and the World Health Organization (WHO) websites were electronically searched to collect guidelines of bronchoscopic alveolar lavage from inception to December 2020. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of the guidelines by using AGREE Ⅱ tool. ResultsA total of 19 guidelines were included, with 5 from China, 5 from the USA, 3 from Europe, 2 from the UK, 1 from Australia, 1 from Israel, 1 from Spain, and 1 from India. The average standard score rates of the 19 guidelines in the six fields were 50.73% for scope and purpose, 20.02% for participants, 15.13% for formulation rigor, 36.40% for clarity of presentation, 3.51% for applicability, and 22.37% for editorial independence.ConclusionsThe quality of bronchoalveolar lavage guidelines remains relatively low.