Study of multidrug resistance in prevalent Gram-negative bacteria in burn patients in Iran: A systematic review and meta-analysis

2019 ◽  
Vol 19 ◽  
pp. 64-72 ◽  
Author(s):  
Fatemeh Javanmardi ◽  
Amir Emami ◽  
Neda Pirbonyeh ◽  
Mahrokh Rajaee ◽  
Gholamreza Hatam ◽  
...  
Keyword(s):  
Systematic Review ◽  
Multidrug Resistance ◽  
Meta Analysis ◽  
Gram Negative Bacteria ◽  
Burn Patients ◽  
Gram Negative

scholarly journals Monotherapy versus combination therapy for multidrug-resistant Gram-negative infections: Systematic Review and Meta-Analysis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Adrian Schmid ◽  
Aline Wolfensberger ◽  
Johannes Nemeth ◽  
Peter W. Schreiber ◽  
Hugo Sax ◽  
...  
Keyword(s):  
Systematic Review ◽  
Combination Therapy ◽  
Meta Analysis ◽  
Blood Stream ◽  
Multidrug Resistant ◽  
Case Control ◽  
Gram Negative Bacteria ◽  
Case Control Studies ◽  
Gram Negative ◽  
Cure Rates

Abstract Infections caused by carbapenemase-producing, multidrug-resistant (MDR), or extensively drug-resistant (XDR) Gram-negative bacteria constitute a major therapeutic challenge. Whether combination antibiotic therapy is superior to monotherapy remains unknown. In this systematic review and meta-analysis OVID MEDLINE, EMBASE, PubMed, The Cochrane Library, and Scopus databases were searched for randomized controlled trials (RCTs) and observational studies published by December 2016 comparing mono- with combination antibiotic therapy for infections with carbapenemase-producing, MDR, or XDR Gram-negative bacteria. Mortality and clinical cure rates served as primary and secondary outcome measures, respectively. Of 8847 initially identified studies, 53 studies – covering pneumonia (n = 10 studies), blood stream (n = 15), osteoarticular (n = 1), and mixed infections (n = 27) - were included. 41% (n = 1848) of patients underwent monotherapy, and 59% (n = 2666) combination therapy. In case series/cohort studies (n = 45) mortality was lower with combination- vs. monotherapy (RR 0.83, CI 0.73–0.93, p = 0.002, I2 = 24%). Subgroup analysis revealed lower mortality with combination therapy with at least two in-vitro active antibiotics, in blood stream infections, and carbapenemase-producing Enterobacteriaceae. No mortality difference was seen in case-control studies (n = 6) and RCTs (n = 2). Cure rates did not differ regardless of study type. The two included RCTs had a high and unknown risk of bias, respectively. 16.7% (1/6) of case-control studies and 37.8% (17/45) of cases series/cohort studies were of good quality, whereas quality was poor in the remaining studies. In conclusion, combination antimicrobial therapy of multidrug-resistant Gram-negative bacteria appears to be superior to monotherapy with regard to mortality.

scholarly journals In vivo studies on antibiotic combination for the treatment of carbapenem-resistant Gram-negative bacteria: a systematic review and meta-analysis protocol

2020 ◽  
Vol 4 (1) ◽  
pp. e100055
Author(s):  
Elda Righi ◽  
Luigia Scudeller ◽  
Margherita Chiamenti ◽  
Kamilia Abdelraouf ◽  
Thomas Lodise ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
In Vivo Models ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
The Impact ◽  
Antibiotic Combination

ObjectiveThere is poor evidence to determine the superiority of combination regimens versus monotherapy against infections due to carbapenem-resistant (CR) Gram-negative bacteria. In vivo models can simulate the pathophysiology of infections in humans and assess antibiotic efficacy. We aim to investigate in vivo effects of antibiotic combination on mortality and disease burden for infections due to CR Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacteriaceae and provide an unbiased overview of existing knowledge. The results of the study can help prioritising future research on the most promising therapies against CR bacteria.Methods and analysisThis protocol was formulated using the Systematic Review Protocol for Animal Intervention Studies (SYRCLE) Checklist. Publications will be collected from PubMed, Scopus, Embase and Web of Science. Quality checklists adapted by Collaborative Approach to Meta-Analysis and Review of Animal Data from Experimental Studies and SYRCLE’s risk of bias tool will be used. If the meta-analysis seems feasible, the ES and the 95% CI will be analysed. The heterogeneity between studies will be assessed by I2 test. Subgroup meta-analysis will be performed when possible to assess the impact of the studies on efficacy of the treatments. Funnel plotting will be used to evaluate the risk of publication bias.DisseminationThis systematic review and meta-analysis is part of a wider research collaboration project, the COmbination tHErapy to treat sepsis due to carbapenem-Resistant bacteria in adult and paediatric population: EvideNCE and common practice (COHERENCE) study that includes also the analyses of in vitro and human studies. Data will be presented at international conferences and the results will be published in peer-reviewed journals.PROSPERO registration numberCRD42019128104(available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019128104).

scholarly journals Modifiable risk factors for multidrug‐resistant Gram‐negative infection in critically ill burn patients: a systematic review and meta‐analysis

2019 ◽  
Vol 89 (10) ◽  
pp. 1256-1260 ◽  
Author(s):  
Mark L. Vickers ◽  
Eva Malacova ◽  
Gabriel J. Milinovich ◽  
Patrick Harris ◽  
Lars Eriksson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Critically Ill ◽  
Meta Analysis ◽  
Multidrug Resistant ◽  
Modifiable Risk Factors ◽  
Burn Patients ◽  
Gram Negative

scholarly journals 475. High Rate of Extended-Spectrum β-Lactamase Producing Gram-Negative Infections and Associated Mortality in Ethiopia: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S232-S232 ◽  
Author(s):  
Tafese B Tufa ◽  
Takele Beyene Tufa ◽  
Fuchs André ◽  
Feldt Torsten
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Multidrug Resistant ◽  
High Rate ◽  
Clinical Samples ◽  
Published Data ◽  
Gram Negative Bacteria ◽  
Salmonella Spp ◽  
Gram Negative ◽  
Extended Spectrum

Abstract Background Extended-spectrum β-lactamase (ESBL)-producing Gram-negative bacteria have become a serious threat to global health. The rapid increase of ESBL-producing bacteria is associated with high mortality due to ineffective antibiotic treatment. To date, regular surveillance of multidrug-resistant (MDR) pathogens is lacking in Ethiopia. For this report, published data regarding ESBL-producing bacteria in different regions of Ethiopia were reviewed systematically. To our knowledge, this is the first systematic review from Ethiopia on ESBL-producing infections and associated mortality in the country. Methods A literature search was conducted in PubMed, PubMed Central, and Google Scholar from January 1, 1990 to April 28, 2019, using the following search terms: “ESBL producing Enterobacteriaceae,” “Gram-negative bacteria infection associated mortality,” and “Ethiopia.” Patient mortality associated with infections by ESBL-producing Gram-negative bacteria was recorded. Results Fourteen publications qualified for review. Totally, 1,782 Gram-negative bacteria isolated from 5,191 clinical samples were included. The phenotypic pooled rate of ESBL-producing Gram-negatives was estimated to be 52.9(95% CI: 50.5%–55.4%). Among different species, ESBL rates were 65. 7% (262/399) Klebsiella spp., 60.6% (20/33) for Enterobacter spp., 47.8% (22/46) for Citrobacter spp., 47.0% (383/815) for E. coli, 45.7% (85/186) for Salmonella spp., 27.8%(15/54) for Proteus spp., 16.7%(4/24) for P. aeruginosa, 14.3% (3/21) for Acinetobacter spps., and 40.5% (15/37) for others, respectively. ESBL genes were confirmed in three studies. blaCTX-M-1 and blaTEM were the predominately detected genes. Two studies reported mortality associated with Gram-negative infections and 86% (12/14) of the patients infected with ESBL-producing bacteria died. Conclusion In this meta-analysis, the pooled phenotypic prevalence of ESBL-producing pathogens is considerably high. Also, the mortality due to ESBL-producers is high but data are scarce. This highlights the need for establishing and upgrading of clinical microbiology laboratories in the country for routine antibiotic susceptibility testing. The capacity to detect ESBL genes is desirable for continuous surveillance of MDR. Disclosures All authors: No reported disclosures.

scholarly journals Prevention and Control of Multidrug-Resistant Gram-Negative Bacteria in Adult Intensive Care Units: A Systematic Review and Network Meta-analysis

2017 ◽  
Vol 64 (suppl_2) ◽  
pp. S51-S60 ◽  
Author(s):  
Nattawat Teerawattanapong ◽  
Kirati Kengkla ◽  
Piyameth Dilokthornsakul ◽  
Surasak Saokaew ◽  
Anucha Apisarnthanarak ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Prevention And Control ◽  
Meta Analysis ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
And Control

scholarly journals Gram-negative neonatal sepsis in low- and lower-middle-income countries and WHO empirical antibiotic recommendations: A systematic review and meta-analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (9) ◽  
pp. e1003787
Author(s):  
Sophie C. H. Wen ◽  
Yukiko Ezure ◽  
Lauren Rolley ◽  
Geoff Spurling ◽  
Colleen L. Lau ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neonatal Sepsis ◽  
Regional Differences ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
Gram Negative Bacteria ◽  
Middle Income ◽  
Gram Negative ◽  
Middle Income Countries ◽  
Gram Negative Organisms

Background Neonatal sepsis is a significant global health issue associated with marked regional disparities in mortality. Antimicrobial resistance (AMR) is a growing concern in Gram-negative organisms, which increasingly predominate in neonatal sepsis, and existing WHO empirical antibiotic recommendations may no longer be appropriate. Previous systematic reviews have been limited to specific low- and middle-income countries. We therefore completed a systematic review and meta-analysis of available data from all low- and lower-middle-income countries (LLMICs) since 2010, with a focus on regional differences in Gram-negative infections and AMR. Methods and findings All studies published from 1 January 2010 to 21 April 2021 about microbiologically confirmed bloodstream infections or meningitis in neonates and AMR in LLMICs were assessed for eligibility. Small case series, studies with a small number of Gram-negative isolates (<10), and studies with a majority of isolates prior to 2010 were excluded. Main outcomes were pooled proportions of Escherichia coli, Klebsiella, Enterobacter, Pseudomonas, Acinetobacter and AMR. We included 88 studies (4 cohort studies, 3 randomised controlled studies, and 81 cross-sectional studies) comprising 10,458 Gram-negative isolates from 19 LLMICs. No studies were identified outside of Africa and Asia. The estimated pooled proportion of neonatal sepsis caused by Gram-negative organisms was 60% (95% CI 55% to 65%). Klebsiella spp. was the most common, with a pooled proportion of 38% of Gram-negative sepsis (95% CI 33% to 43%). Regional differences were observed, with higher proportions of Acinetobacter spp. in Asia and Klebsiella spp. in Africa. Resistance to aminoglycosides and third-generation cephalosporins ranged from 42% to 69% and from 59% to 84%, respectively. Study limitations include significant heterogeneity among included studies, exclusion of upper-middle-income countries, and potential sampling bias, with the majority of studies from tertiary hospital settings, which may overestimate the burden caused by Gram-negative bacteria. Conclusions Gram-negative bacteria are an important cause of neonatal sepsis in LLMICs and are associated with significant rates of resistance to WHO-recommended first- and second-line empirical antibiotics. AMR surveillance should underpin region-specific empirical treatment recommendations. Meanwhile, a significant global commitment to accessible and effective antimicrobials for neonates is required.

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