Abstract
BackgroundOwing to their resistance to an important class of antibiotics, the prevention and treatment of carbapenem-resistant (CR)/non-susceptible Gram-negative (GN) infections has become an important public health objective. We conducted a systematic review and meta-analysis of published literature to evaluate the burden of CR GN infections, focusing on high-risk patients such as transplant recipients, or patients with cancer, renal impairment, or sepsis.MethodsMEDLINE®, Cochrane Central, and Embase® were searched between 2010 and March 2019. s and full-text articles were screened in duplicate. Random effects meta-analysis was conducted when reported outcomes were sufficiently similar.ResultsTwenty-six publications were eligible. Meta-analyses found increased mortality associated with CR infections among high-risk patients in both unadjusted analysis (8 studies; summary unadjusted odds ratio [OR]: 5.85; 95% confidence interval [CI]: 3.69, 9.26; I2 = 19.8%) and adjusted analysis (5 studies; summary hazard ratio [HR]: 4.67; 95% CI: 2.18, 9.99; I2 = 77.7%), compared to patients with carbapenem-susceptible (CS) infections or no infection. Increased mortality was also seen in subgroup analyses by length of follow-up (either short-term or long-term) or causative pathogen. A limited number of studies found that CR GN infections increased the risk for mechanical ventilation, adverse events such as graft failure or acute rejection in solid organ transplant recipients, increased renal failure or nephrotoxicity, and an increase in readmissions and costs, though the findings reported in the literature were not consistent.ConclusionThis systematic literature review and meta-analysis indicates that CR GN infections in high-risk patients are associated with increased mortality, emphasizing the need for antimicrobial stewardship and infection control in hospitals which treat high-risk patients and for the development of effective antimicrobials with favorable efficacy and safety profiles for the treatment of CR GN infections.
Highlights
An alarming increase in antibiotic-resistant Gram-negative (GN) infections represents a burden on healthcare systems globally [1,2,3]
The increase in CR GN infections has led to a resurgence in the use of older antibiotics i.e., broad antimicrobial therapies such as polymyxins that were seldom utilized in the recent past due to efficacy, dosing, and/or toxicity concerns [5]
Data sources and study eligibility A comprehensive search to evaluate contemporary literature was conducted in the MEDLINE®, Cochrane Central, and Embase® databases from January 2010 through March 2019 for citations that included terms related to pathogens (e.g., Klebsiella, Pseudomonas, Escherichia), mode of infection, carbapenem resistance (e.g., [carbapenem, imipenem, meropenem] and resistant), treatment setting, and patient characteristics
Summary
An alarming increase in antibiotic-resistant Gram-negative (GN) infections represents a burden on healthcare systems globally [1,2,3]. Certain risk factors increase the likelihood of a patient becoming colonized or infected with GN bacteria These include exposure to healthcare settings [6,7,8,9], use of invasive devices or procedures [10,11,12], receipt of prior antimicrobial therapy [13], foreign travel [14, 15], and being classified as ‘high-risk’ [16,17,18]. Given the lack of comprehensive information on these important patient populations, we propose to conduct a systematic literature review (SLR) evaluating recent studies on the burden of CR GN infections among high-risk patients Owing to their resistance to an important class of antibiotics, the prevention and treatment of carbapenem-resistant (CR)/non-susceptible Gram-negative (GN) infections has become an important public health objective. Random effects meta-analysis was conducted when reported outcomes were sufficiently similar
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
