scholarly journals Risk of infection in antimicrobial-resistant Gram-negative bacteria carriers: A systematic review

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
G Arzilli ◽  
G Scardina ◽  
V Casigliani ◽  
M Moi ◽  
E Lucenteforte ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hospital Admission ◽  
Infection Rate ◽  
High Income ◽  
Attributable Mortality ◽  
Gram Negative Bacteria ◽  
Term Care ◽  
Gram Negative ◽  
Hospitalised Patients ◽  
Risk Of Progression

Abstract Background Antimicrobial-resistant Gram-negative bacteria (AMR-GNB) have emerged as important health care-associated pathogens. Infections with AMR-GNB are associated with high patient morbidity and attributable mortality. Colonization is a prerequisite for infection, however the extent to which colonized patients develop infection is unclear. This systematic review explored the risk of developing infection during hospitalisation among AMR-GNB faecal carriers. Also, we investigated the acquisition rate for AMR-GNB colonization among patients not colonized at admission. Methods We searched on PubMed, Scopus and Cochrane databases for studies published from 2010 up to April 2019. We included studies reporting on hospitalised patients ≥18 years old in high-income countries (excluding long-term care facilities). Results Out of 9496 articles, 55 studies fulfilled our inclusion criteria. Forty-two studies reported data from EU/EEA, 6 from USA and 7 from other regions. Almost all studies (n = 45) were conducted in university hospitals. Most studies (n = 41;74.5%) were performed in high-risk wards (ICU, haematology, burn units and transplant units). Out of 55 studies, 8 examined AMR-GNB, 27 Enterobacteriaceae, while the others investigated specific pathogens: Klebsiella spp. (n = 11), E. Coli (n = 2), A. Baumannii (n = 3) and P. Aeruginosa (n = 4). The rate of AMR-GNB carriage acquisition was 10.5% (n = 40 studies; 95% CI:8.2-13.1). The risk of progression to infection among patients colonized at hospital admission was 13.9% (n = 15; 5.4-24.9), while the infection rate in patients who acquired carriage during hospitalization was 23.0% (n = 7; 5.9-45.2). Patients with an undefined time of colonization presented an infection rate of 16.9% (n = 13; 11.2-23.4). Considering these three populations as a whole, the risk of developing infection was 16.0% (11.0-21.0). Conclusions Our results suggest that risk of progression to infection in AMR-GNB colonized patients in hospital setting is high. Key messages The aim of our study was to estimate the risk of progression to infection, during hospital stay, in patients colonized by AMR-GNB at hospital admission in high-income countries. Our results suggest that faecal colonization with AMR-GNB poses a 16.0% risk of subsequent AMR-GNB infection. This risk in higher (23.0%) in patients who acquired colonization during hospitalisation.

scholarly journals Systematic review on Screening for antimicrobial-resistant Gram-negative bacteria in inpatients

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
G Scardina ◽  
G Arzilli ◽  
V Casigliani ◽  
M Moi ◽  
E Lucenteforte ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hospital Admission ◽  
High Income ◽  
Gram Negative Bacteria ◽  
Term Care ◽  
Gram Negative ◽  
Multiple Risks ◽  
Oncologic Patients ◽  
Clinical Conditions ◽  
Screening Approaches

Abstract Background Infections with antimicrobial-resistant Gram-negative bacteria (AMR-GNB) are increasingly being reported worldwide. Early identification of carriage at hospital admission is essential to reduce the risk of onward transmission within the health facility. This systematic review aimed at exploring screening practices for AMR-GNB faecal colonization among patients on admission to hospital in high-income countries and estimating its prevalence. Methods We searched on Pubmed, Scopus and Cochrane databases for studies published from 2010 up to April 2019. We included studies reporting on patients ≥18 years old and hospitalised (excluding long-term care facilities). Results The search retrieved 9496 articles, 85 were included after screening: 10 reported screening activities in outbreak situations (not included in the analysis); 75 in non-outbreak situations. Based on the target patient groups and setting we identified four subsets of screening approaches: all admitted (AA) in high risk (HR) wards (36 studies, 48%), HR patients in HR wards (12, 16%), HR patients in low risk wards (LRW) (11; 15%) and AA - LRW (15, 20%). HR patients-based screening targeted patients with certain clinical conditions (mostly oncologic patients, 37%), travellers 29%, previously hospitalised and individuals with multiple risks 34%. HR wards-based screening was performed mostly in ICU (73%), while LRW-based screening in hospital-wide setting (58%). We investigated the overall prevalence rates of AMR-GNB (15.1%; 95%CI: 9.5-21.6), Klebsiella spp (KB) (4.1%; 3.1-5.3), E. coli (9.6%; 7.7-11.7) P. Aeruginosa (7.6%; 1.7-16.8), A. Baumannii (2.1%; 0.5-4.4) and other Enterobacterales (0.8%; 0.59-1.1). Reported KB-prevalence varied according to screening approaches, with statistically significant higher prevalence in HR wards. Conclusions According to our data, screening for AMR-GNB mostly followed targeted approaches. Overall prevalence of AMR-GNB carriage at hospital admission was considerable. Key messages This systematic review gives un overview on the screening procedures for AMR-GNB faecal colonization among patients on hospital admission in high-income countries. According to our results, overall prevalence of AMR-GNB carriage was considerable (15.1%), varying among specific pathogens but with no significant correlation with screening approaches, except for KB.

scholarly journals Influx of Multidrug-Resistant, Gram-Negative Bacteria in the Hospital Setting and the Role of Elderly Patients With Bacterial Bloodstream Infection

2009 ◽  
Vol 30 (4) ◽  
pp. 325-331 ◽  
Author(s):  
Aurora Pop-Vicas ◽  
E. Tacconelli ◽  
Stefan Gravenstein ◽  
Bing Lu ◽  
Erika M. C. D'Agata
Keyword(s):  
Elderly Patients ◽  
Hospital Admission ◽  
Long Term Care ◽  
Clinical Epidemiology ◽  
Hospital Setting ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Term Care ◽  
Gram Negative

Background.Multidrug-resistant (MDR) gram-negative bacteria are reported increasingly frequently among isolates recovered from elderly patients. The clinical epidemiology of bloodstream infection (BSI) due to MDR gram-negative bacteria among elderly patients is unknown.Objective.To characterize the clinical epidemiology of BSI due to MDR gram-negative bacteria among elderly patients at hospital admission in an effort to provide a greater understanding of these serious infections and ultimately to improve patient outcomes.Design.Case-control study.Setting.Tertiary care hospital in Boston, Massachusetts.Patients.Patients 65 years of age and older.Methods.From 1999 to 2007, computerized medical records were reviewed for BSI due to MDR gram-negative bacteria within 48 hours of hospital admission. Risk factors for BSI due to these bacteria were identified.Results.MDR gram-negative bacteria were recovered from 61 (8%) of 724 elderly patients with BSI caused by gram-negative bacteria. Over the -year study period, the percentage of MDR gram-negative bacteria among bloodstream isolates increased from 2 (1%) of 199 to 34 (16%) of 216. Empiric therapy was ineffective for 38 (63%) of 60 patients with BSI caused by MDR gram-negative bacteria. The variables independently associated with BSI due to these bacteria were as follows: residency in a long-term care facility (odds ratio [OR], 4.9 [95% confidence interval {CI} 1.6–14.9]; P = .006), presence of an invasive device (OR, 6.0 [95% CI, 1.5–23.5]; P = .01), severe sepsis (OR, 7.9 [95% CI, 1.7–37.1]; P = .009), and delayed initiation of effective therapy (OR, 12.8 [95% CI, 3.9–41.1]; P<.001).Conclusion.The 16-fold increase in BSI due to MDR gram-negative bacteria at hospital admission among elderly patients, especially among those who resided in long-term care facilities prior to admission, contributes further to the expanding body of evidence that these patients are the main reservoirs of MDR gram-negative bacteria. Given their contribution to the influx of antimicrobial-resistant bacteria in the hospital setting, infection control interventions that target this high-risk group need to be considered.

Low prevalence of colonization with multidrug-resistant gram-negative bacteria in long-term care facilities in Graz, Austria

2018 ◽  
Vol 46 (1) ◽  
pp. 76-80 ◽  
Author(s):  
Eva Leitner ◽  
Elisabeth Zechner ◽  
Elisabeth Ullrich ◽  
Gernot Zarfel ◽  
Josefa Luxner ◽  
...  
Keyword(s):  
Long Term Care ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Term Care ◽  
Gram Negative ◽  
Care Facilities ◽  
Low Prevalence

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.

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