scholarly journals Double-carbapenem therapy in the treatment of multidrug resistant Gram-negative bacterial infections: a systematic review and meta-analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yuan-yuan Li ◽  
Jin Wang ◽  
Rui Wang ◽  
Yun Cai
Keyword(s):  
Systematic Review ◽  
Bacterial Infections ◽  
Meta Analysis ◽  
Multidrug Resistant ◽  
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 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 Global Burden of Colistin-Resistant Bacteria: Mobilized Colistin Resistance Genes Study (1980–2018)

2019 ◽  
Vol 7 (10) ◽  
pp. 461 ◽  
Author(s):  
Elbediwi ◽  
Li ◽  
Paudyal ◽  
Pan ◽  
Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bacterial Infections ◽  
Meta Analysis ◽  
Food Products ◽  
Multidrug Resistant ◽  
Accurate Estimate ◽  
Resistant Bacteria ◽  
Colistin Resistance ◽  
Cochrane Database ◽  
Control And Prevention

Colistin is considered to be an antimicrobial of last-resort for the treatment of multidrug-resistant Gram-negative bacterial infections. The recent global dissemination of mobilized colistin resistance (mcr) genes is an urgent public health threat. An accurate estimate of the global prevalence of mcr genes, their reservoirs and the potential pathways for human transmission are required to implement control and prevention strategies, yet such data are lacking. Publications from four English (PubMed, Scopus, the Cochrane Database of Systematic Reviews and Web of Science) and two Chinese (CNKI and WANFANG) databases published between 18 November 2015 and 30 December 2018 were identified. In this systematic review and meta-analysis, the prevalence of mcr genes in bacteria isolated from humans, animals, the environment and food products were investigated. A total of 974 publications were identified. 202 observational studies were included in the systematic review and 71 in the meta-analysis. mcr genes were reported from 47 countries across six continents and the overall average prevalence was 4.7% (0.1–9.3%). China reported the highest number of mcr-positive strains. Pathogenic Escherichia coli (54%), isolated from animals (52%) and harboring an IncI2 plasmid (34%) were the bacteria with highest prevalence of mcr genes. The estimated prevalence of mcr-1 pathogenic E. coli was higher in food-animals than in humans and food products, which suggests a role for foodborne transmission. This study provides a comprehensive assessment of prevalence of the mcr gene by source, organism, genotype and type of plasmid.

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 Intravenous colistin use for infections due to multidrug-resistant gram-negative bacilli in critically ill paediatric patients: a systematic review and meta-analysis

2018 ◽  
Author(s):  
Spyridon A. Karageorgos ◽  
Hamid Bassiri ◽  
George Siakallis ◽  
Michael Miligkos ◽  
Constantinos Tsioutis
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Meta Analysis ◽  
Age Groups ◽  
Clinical Effectiveness ◽  
Multidrug Resistant ◽  
Loading Dose ◽  
Gram Negative ◽  
Paediatric Patients ◽  
Tract Infections

SynopsisBackgroundData are limited regarding the clinical effectiveness and safety of intravenous colistin for treatment of infections by multidrug-resistant gram-negative bacilli (MDR-GNB) in the paediatric intensive care unit (PICU).MethodsSystematic review of intravenous colistin use in critically ill paediatric patients with MDR-GNB infection in PubMed, Scopus and Embase (through January 31st, 2018).ResultsOut of 1,181 citations, 7 studies were included on the use of intravenous colistin for 405 patients in PICU. Majority of patients were diagnosed with lower respiratory tract infections, with Acinetobacter baumannii being the predominant pathogen. Colistin dosages ranged between 2.6-18 mg/kg/day, with none but one case reporting a loading dose. Emergence of colistin-resistance during treatment was reported in two cases. Nephrotoxicity and neurotoxicity were reported in 6.1% and 0.5% respectively, but concomitant medications and severe underlying illness limited our ability to definitively associate use of colistin with nephrotoxicity. Crude mortality was 29.5% (95%CI 21.7-38.1%), whereas infection-related mortality was 16.6% (95%CI 12.2-21.5%).ConclusionsWhile the reported incidence of adverse events related to colistin were low, reported mortality rates for infections by MDR-GNB in PICU were notable. In addition to severity of disease and comorbidities, inadequate daily dosage and the absence of a loading dose may have contributed to mortality. As the use of colistin for treatment of MDR-GNB infections increases, it is imperative to understand whether optimal dosing of colistin in paediatric patients differs across different age groups. As such, future studies to establish the pharmacokinetic properties of colistin in different paediatric settings are warranted.

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