Abstract
Background Multidrug-resistant (MDR) bacteria are the main cause of lower respiratory tract infections (LRTIs) with high mortality. The purpose of this study is to identify the risk factors associated with MDR by performing a systematic review and meta-analysis. Methods PubMed, EMBASE (via Ovid), and Cochrane Library were systematically searched for studies on the risk factors for MDR bacteria in LRTIs as of November 30, 2019. Literature screening, data abstraction, and quality assessment of the eligible studies were performed independently by two researchers. Results A total of 3,607 articles were retrieved, of which 21 articles representing 20 cohort studies published in English were included after title/abstract and full-text screening. Among the 21 articles involving 7,650 patients and 1,360 MDR organisms, ten reported the risk factors for MDR Gram-positive bacteria (GPB) and Gram-negative bacteria (GNB), ten for MDR GNB, and one for MDR GPB. The meta-analysis results suggested that prior antibiotic treatment, inappropriate antibiotic therapy, chronic lung disease, chronic liver disease and cerebral disease, prior MDR and PA infection/colonization, recent hospitalization, longer hospitalization stay, endotracheal tracheostomy and mechanical ventilation, tube feeding, nursing home residence, and higher disease severity score were independent risk factors for MDR bacteria. Conclusions This review identified fourteen clinical factors that might increase the risk of MDR bacteria in patients with LRTIs. Clinicians could take into account these factors when selecting antibiotics for patients and determine whether coverage for MDR bacteria is required. More well-designed studies are needed to confirm the various risk factors for MDR bacteria in the future.
Highlights
lower respiratory tract infections (LRTIs) are a leading cause of morbidity and mortality around the world
One definition of MDR is the development of resistance to more than three antibiotic classes known to be active against these pathogens [22] (Definition A), and the other considered methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamases (ESBLs), carbapenem-resistant Klebsiella pneumoniae (CRKP) and Escherichia coli (Eco), Pseudomonas aeruginosa (PA), Acinetobacter baumannii (AB), and Stenotrophomonas maltophilia (SMA) as MDR pathogens according to the IDSA/ATS Guidelines 2005 [23] (Definition B)
Except for an international multicenter study [16, 17], all other studies [14, 15, 19, 26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41] were confined to one country. e majority of the populations included were patients with pneumonia [14,15,16,17, 26,27,28,29, 31,32,33,34,35,36,37,38,39,40,41]. e mean age of the study subjects ranged from 42.6 years to 74.9 years, and the males accounted for 44.5% to 89.7% of all the study subjects
Summary
PubMed, EMBASE (via Ovid), and Cochrane Library were systematically searched for studies on the risk factors for MDR bacteria in LRTIs as of November 30, 2019. Literature screening, data abstraction, and quality assessment of the eligible studies were performed independently by two researchers. E meta-analysis results suggested that prior antibiotic treatment, inappropriate antibiotic therapy, chronic lung disease, chronic liver disease and cerebral disease, prior MDR and PA infection/colonization, recent hospitalization, longer hospitalization stay, endotracheal tracheostomy and mechanical ventilation, tube feeding, nursing home residence, and higher disease severity score were independent risk factors for MDR bacteria. Is review identified fourteen clinical factors that might increase the risk of MDR bacteria in patients with LRTIs. Clinicians could take into account these factors when selecting antibiotics for patients and determine whether coverage for MDR bacteria is required. More well-designed studies are needed to confirm the various risk factors for MDR bacteria in the future
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