PDF(Pubmed)
Abstract：
Background: Despite the rapid spread of extended-spectrum beta-lactamase (ESBL) producing-Enterobacterales (ESBL-E) and carbapenemase-producing Enterobacterales (CPE), little is known about the extent of their prevalence in the Greater Mekong Subregion (GMS). In this systematic review, we aimed to determine the epidemiology of ESBL-E and CPE in clinically significant Enterobacterales: Escherichia coli and Klebsiella pneumoniae from the GMS (comprising of Cambodia, Laos, Myanmar, Thailand, Vietnam and Yunnan province and Guangxi Zhuang region of China). Methods: Following a list of search terms adapted to subject headings, we systematically searched databases: Medline, EMBASE, Scopus and Web of Science for articles published on and before October 20th, 2020. The search string consisted of the bacterial names, methods involved in detecting drug-resistance phenotype and genotype, GMS countries, and ESBL and carbapenemase detection as the outcomes. Meta-analyses of the association between the isolation of ESBL from human clinical and non-clinical specimens were performed using the \"METAN\" function in STATA 14. Results: One hundred and thirty-nine studies were included from a total of 1,513 identified studies. Despite the heterogeneity in study methods, analyzing the prevalence proportions on log-linear model scale for ESBL producing-E. coli showed a trend that increased by 13.2% (95%CI: 6.1-20.2) in clinical blood specimens, 8.1% (95%CI: 1.7-14.4) in all clinical specimens and 17.7% (95%CI: 4.9-30.4) increase in carriage specimens. Under the log-linear model assumption, no significant trend over time was found for ESBL producing K. pneumoniae and ESBL-E specimens. CPE was reported in clinical studies and carriage studies past 2010, however a trend could not be determined because of the small dataset. Twelve studies were included in the meta-analysis of risk factors associated with isolation of ESBL. Recent antibiotic exposure was the most studied variable and showed a significant positive association with ESBL-E isolation (pooled OR: 2.9, 95%CI: 2.3-3.8) followed by chronic kidney disease (pooled OR: 4.7, 95%CI: 1.8-11.9), and other co-morbidities (pooled OR: 1.6, 95%CI: 1.2-2.9). Conclusion: Data from GMS is heterogeneous with significant data-gaps, especially in community settings from Laos, Myanmar, Cambodia and Yunnan and Guangxi provinces of China. Collaborative work standardizing the methodology of studies will aid in better monitoring, surveillance and evaluation of interventions across the GMS.
摘要：
背景：尽管产超广谱β-内酰胺酶（ESBL）的肠杆菌（ESBL-E）和产碳青霉烯酶的肠杆菌（CPE）迅速传播，人们对它们在大湄公河次区域(GMS)的流行程度知之甚少。在这次系统审查中，我们旨在确定ESBL-E和CPE在具有临床意义的肠杆菌中的流行病学：来自GMS的大肠杆菌和肺炎克雷伯菌（包括柬埔寨，老挝,缅甸,泰国,越南和云南省和中国广西壮族自治区）。方法：在适应主题标题的搜索词列表之后，我们系统地搜索了数据库：Medline，EMBASE,Scopus和WebofScience在10月20日之前发表的文章，2020年。搜索字符串由细菌名称组成，涉及检测耐药表型和基因型的方法，GMS国家,和ESBL和碳青霉烯酶检测作为结果。使用STATA14中的“METAN”功能，对从人类临床和非临床标本中分离ESBL之间的关联进行了荟萃分析。结果：从总共1,513项确定的研究中纳入了139项研究。尽管研究方法存在异质性，在对数线性模型量表上分析ESBL产生E的患病率比例。大肠杆菌在临床血液标本中呈增加13.2%(95CI:6.1-20.2)的趋势，所有临床标本中的8.1％（95CI：1.7-14.4）和运输标本中的17.7％（95CI：4.9-30.4）增加。在对数线性模型假设下，对于产ESBL的肺炎克雷伯菌和ESBL-E标本,没有发现随时间的显著趋势.在2010年的临床研究和运输研究中报道了CPE，但是由于数据集小，无法确定趋势。12项研究被纳入与ESBL分离相关的危险因素的荟萃分析。最近的抗生素暴露是研究最多的变量，并显示与ESBL-E分离（合并OR：2.9，95CI：2.3-3.8）显着正相关，其次是慢性肾脏疾病（合并OR：4.7，95CI：1.8-11.9），和其他合并症（合并OR：1.6，95CI：1.2-2.9）。结论：来自GMS的数据是异质的，具有显著的数据缺口，特别是在老挝的社区环境中，缅甸,柬埔寨和中国的云南和广西。标准化研究方法的协作工作将有助于更好地监测，监测和评估整个GMS的干预措施。
