Association Between Carbapenem Resistance and Mortality Among Adult, Hospitalized Patients With Serious Infections Due to Enterobacteriaceae: Results of a Systematic Literature Review and Meta-analysis

Abstract This study quantified mortality associated with serious infections caused by carbapenem-resistant (CRE) and carbapenem-susceptible Enterobacteriaceae (CSE). A systematic literature review was conducted, evaluating outcomes in hospitalized patients with CRE infections from a blood, urinary, pulmonary, or intra-abdominal source. A meta-analysis (MA) calculating odds ratios (ORs) for mortality was performed. Twenty-two studies met the criteria for inclusion in the MA: 12 included mortality data for CRE vs CSE populations. Compared with CSE, CRE was associated with a significantly higher risk of overall mortality (OR, 3.39; 95% confidence interval [CI], 2.35–4.89), as was monotherapy (vs combination therapy) treatment of patients with CRE infections (OR, 2.19; 95% CI, 1.00–4.80). These results document the increased mortality associated with serious CRE infections compared with CSE infections among hospitalized adults. It will be important to reevaluate the mortality in CRE and CSE populations, especially among patients who receive early appropriate therapy, as new antibiotics become available.

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Association Between Carbapenem Resistance and Mortality Among Adults Hospitalized With Serious Infections Due to an Enterobacteriaceae spp: Results of a Systematic Literature Review and Meta-Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.219 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Cited By ~ 1

Author(s):

Amber Martin ◽

Kyle Fahrbach ◽

Qi Zhao ◽

Thomas Lodise

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Meta Analysis ◽

Carbapenem Resistance ◽

Serious Infections

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Safety of synthetic and biological DMARDs: a systematic literature review informing the 2016 update of the EULAR recommendations for management of rheumatoid arthritis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2016-210708 ◽

2017 ◽

Vol 76 (6) ◽

pp. 1101-1136 ◽

Cited By ~ 153

Author(s):

Sofia Ramiro ◽

Alexandre Sepriano ◽

Katerina Chatzidionysiou ◽

Jackie L Nam ◽

Josef S Smolen ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Literature Review ◽

Systematic Literature Review ◽

Observational Studies ◽

Meta Analysis ◽

Risk Of Bias ◽

Eligibility Criteria ◽

Increased Risk ◽

Serious Infections ◽

Safety Outcomes

ObjectivesTo assess the safety of synthetic (s) and biological (b) disease-modifying antirheumatic drugs (DMARDs) for the management of rheumatoid arthritis (RA) to inform the European League Against Rheumatism recommendations for the management of RA.MethodsSystematic literature review (SLR) of observational studies comparing any DMARD with another intervention for the management of patients with RA. All safety outcomes were included. A comparator group was required for the study to be included. Risk of bias was assessed with the Hayden's tool.ResultsTwenty-six observational studies addressing diverse safety outcomes of therapy with bDMARDs met eligibility criteria (15 on serious infections, 4 on malignancies). Substantial heterogeneity precluded meta-analysis. Together with the evidence from the 2013 SLR, based on 15 studies, 7 at low risk of bias, patients on bDMARDs compared with patients on conventional sDMARDs had a higher risk of serious infections (adjusted HR (aHR) 1.1 to 1.8)—without differences across bDMARDs—a higher risk of tuberculosis (aHR 2.7 to 12.5), but no increased risk of infection by herpes zoster. Patients on bDMARDs did not have an increased risk of malignancies in general, lymphoma or non-melanoma skin cancer, but the risk of melanoma may be slightly increased (aHR 1.5).ConclusionsThese findings confirm the known safety pattern of bDMARDs, including both tumour necrosis factor-α inhibitor (TNFi) and non-TNFi, for the treatment of RA.

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