A systematic review on the excess health risk of antibiotic-resistant bloodstream infections for six key pathogens in Europe.
Clin Microbiol Infect
; 30 Suppl 1: S14-S25, 2024 Mar.
Article
in En
| MEDLINE
| ID: mdl-37802750
ABSTRACT
BACKGROUND:
Antimicrobial resistance is a global threat, which requires novel intervention strategies, for which priority pathogens and settings need to be determined.OBJECTIVES:
We evaluated pathogen-specific excess health burden of drug-resistant bloodstream infections (BSIs) in Europe.METHODS:
A systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, and grey literature for the period January 1990 to May 2022. STUDY ELIGIBILITY CRITERIA Studies that reported burden data for six key drug-resistant pathogens carbapenem-resistant (CR) Pseudomonas aeruginosa and Acinetobacter baumannii, third-generation cephalosporin or CR Escherichia coli and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium. Excess health outcomes compared with drug-susceptible BSIs or uninfected patients. For MRSA and third-generation cephalosporin E. coli and K. pneumoniae BSIs, five or more European studies were identified. For all others, the search was extended to high-income countries.PARTICIPANTS:
Paediatric and adult patients diagnosed with drug-resistant BSI.INTERVENTIONS:
Not applicable. ASSESSMENT OF RISK OF BIAS An adapted version of the Joanna-Briggs Institute assessment tool. METHODS OF DATASYNTHESIS:
Random-effect models were used to pool pathogen-specific burden estimates.RESULTS:
We screened 7154 titles, 1078 full-texts and found 56 studies on BSIs. Most studies compared outcomes of drug-resistant to drug-susceptible BSIs (46/56, 82.1%), and reported mortality (55/56 studies, 98.6%). The pooled crude estimate for excess all-cause mortality of drug-resistant versus drug-susceptible BSIs ranged from OR 1.31 (95% CI 1.03-1.68) for CR P. aeruginosa to OR 3.44 (95% CI 1.62-7.32) for CR K. pneumoniae. Pooled crude estimates comparing mortality to uninfected patients were available for vancomycin-resistant Enterococcus and MRSA BSIs (OR of 11.19 [95% CI 6.92-18.09] and OR 6.18 [95% CI 2.10-18.17], respectively).CONCLUSIONS:
Drug-resistant BSIs are associated with increased mortality, with the magnitude of the effect influenced by pathogen type and comparator. Future research should address crucial knowledge gaps in pathogen- and infection-specific burdens to guide development of novel interventions.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Bacteremia
/
Sepsis
/
Methicillin-Resistant Staphylococcus aureus
Type of study:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Limits:
Adult
/
Child
/
Humans
Country/Region as subject:
Europa
Language:
En
Journal:
Clin Microbiol Infect
Journal subject:
DOENCAS TRANSMISSIVEIS
/
MICROBIOLOGIA
Year:
2024
Document type:
Article
Affiliation country:
Switzerland