Abstract：
This systematic review aims to summarize the evidence on the effects of screening strategies to detect carbapenem-resistant gram-negative bacteria (Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa).
Eligible studies were randomized trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series. We conducted searches in CENTRAL, PUBMED, Embase, Epistemonikos, and in multiple databases available in the Virtual Health Library (LILACS, Scielo, WHO IBECS, and PAHO IBECS). All the searches covered the period until 4 June 2021. No date or language restrictions were applied. Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria, and extracted data on study characteristics, methods, outcomes, and risk of bias, using a predesigned standardized form. When possible, we intended to conduct meta-analyses using a random-effect model. We assessed the certainty of the evidence (CoE) and summarized the results using the GRADE approach.
Our search strategy yielded 57,451 references. No randomized trials were identified. Sixteen studies (one controlled before-after study and 15 interrupted time series) met our inclusion criteria and were included in the review. Most studies were conducted in tertiary care general hospitals from the United States, Europe, and Asia. Eleven studies included adult patients hospitalized in general wards and intensive care units, one was carried out in a neonatal intensive care unit, two in hematology or oncology units, and one in a solid organ transplantation department. Eleven studies were conducted in the setting of an outbreak. Regarding the detection strategy used, all studies included screening strategies for high-risk patients at the moment of admission and 7 studies reported a contact surveillance strategy. Most studies were conducted in settings where infection prevention and control measures were concomitantly installed or reinforced. Data were not suitable for meta-analysis, so the results were presented as a narrative synthesis. Most studies showed a decline in the prevalence of both infection and colonization rates after the implementation of a policy of active surveillance, but the CoE is low. Screening strategies may result in little to no difference in the risk of all-cause mortality and the length of hospital stay.
Existing evidence may favor the use of surveillance culture to carbapenem-resistant gram-negative bacteria, but its quality is poor, so solid conclusions cannot be drawn. Well-conducted randomized trials or high-quality quasi-experimental studies are needed to improve the certainty of the existing evidence. These studies should assess the effect of the addition of screening strategies as a single intervention and measure clinically important outcomes such as infection, length of hospital stay, and mortality.
Eligible studies were randomized trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series. We conducted searches in CENTRAL, PUBMED, Embase, Epistemonikos, and in multiple databases available in the Virtual Health Library (LILACS, Scielo, WHO IBECS, and PAHO IBECS). All the searches covered the period until 4 June 2021. No date or language restrictions were applied. Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria, and extracted data on study characteristics, methods, outcomes, and risk of bias, using a predesigned standardized form. When possible, we intended to conduct meta-analyses using a random-effect model. We assessed the certainty of the evidence (CoE) and summarized the results using the GRADE approach.
Our search strategy yielded 57,451 references. No randomized trials were identified. Sixteen studies (one controlled before-after study and 15 interrupted time series) met our inclusion criteria and were included in the review. Most studies were conducted in tertiary care general hospitals from the United States, Europe, and Asia. Eleven studies included adult patients hospitalized in general wards and intensive care units, one was carried out in a neonatal intensive care unit, two in hematology or oncology units, and one in a solid organ transplantation department. Eleven studies were conducted in the setting of an outbreak. Regarding the detection strategy used, all studies included screening strategies for high-risk patients at the moment of admission and 7 studies reported a contact surveillance strategy. Most studies were conducted in settings where infection prevention and control measures were concomitantly installed or reinforced. Data were not suitable for meta-analysis, so the results were presented as a narrative synthesis. Most studies showed a decline in the prevalence of both infection and colonization rates after the implementation of a policy of active surveillance, but the CoE is low. Screening strategies may result in little to no difference in the risk of all-cause mortality and the length of hospital stay.
Existing evidence may favor the use of surveillance culture to carbapenem-resistant gram-negative bacteria, but its quality is poor, so solid conclusions cannot be drawn. Well-conducted randomized trials or high-quality quasi-experimental studies are needed to improve the certainty of the existing evidence. These studies should assess the effect of the addition of screening strategies as a single intervention and measure clinically important outcomes such as infection, length of hospital stay, and mortality.
摘要：
目的：本系统综述旨在总结筛选策略检测碳青霉烯类耐药革兰阴性菌（肠杆菌科，鲍曼不动杆菌,和铜绿假单胞菌)。
方法：符合条件的研究是随机试验，非随机对照试验，控制前后研究，和中断的时间序列。我们在中部进行了搜索，pubmed,Embase,认识论，以及虚拟健康库(LILACS，Scielo,世卫组织IBECS，和泛美IBECS）。所有搜索都涵盖了2021年6月4日之前的时间。未应用日期或语言限制。两名评审员根据预定义的选择标准独立评估潜在合格的研究，并提取了有关研究特征的数据，方法,结果，和偏见的风险，使用预先设计的标准化表格。如果可能,我们打算使用随机效应模型进行荟萃分析.我们评估了证据的确定性（CoE），并使用GRADE方法总结了结果。
结果：我们的搜索策略获得了57,451个参考。没有发现随机试验。16项研究（一项前后对照研究和15项中断时间序列）符合我们的纳入标准，并被纳入审查。大多数研究是在美国的三级护理综合医院进行的，欧洲,和亚洲。11项研究包括在普通病房和重症监护病房住院的成年患者，其中一次是在新生儿重症监护室进行的，两个在血液科或肿瘤科，还有一个在实体器官移植科。在爆发的背景下进行了11项研究。关于使用的检测策略，所有研究均包括高危患者入院时的筛查策略,7项研究报告了接触监测策略.大多数研究是在同时安装或加强感染预防和控制措施的环境中进行的。数据不适合进行荟萃分析，所以结果被呈现为叙事综合。大多数研究表明，在实施积极监测政策后，感染率和定植率都有所下降，但CoE很低.筛查策略可能导致全因死亡率和住院时间的风险几乎没有差异。
结论：现有证据可能支持对碳青霉烯类耐药革兰阴性菌进行监测培养，但是它的质量很差，所以不能得出可靠的结论。需要进行良好的随机试验或高质量的准实验研究来提高现有证据的确定性。这些研究应评估添加筛查策略作为单一干预措施的效果，并测量临床上重要的结局，例如感染，住院时间,和死亡率。
方法：符合条件的研究是随机试验，非随机对照试验，控制前后研究，和中断的时间序列。我们在中部进行了搜索，pubmed,Embase,认识论，以及虚拟健康库(LILACS，Scielo,世卫组织IBECS，和泛美IBECS）。所有搜索都涵盖了2021年6月4日之前的时间。未应用日期或语言限制。两名评审员根据预定义的选择标准独立评估潜在合格的研究，并提取了有关研究特征的数据，方法,结果，和偏见的风险，使用预先设计的标准化表格。如果可能,我们打算使用随机效应模型进行荟萃分析.我们评估了证据的确定性（CoE），并使用GRADE方法总结了结果。
结果：我们的搜索策略获得了57,451个参考。没有发现随机试验。16项研究（一项前后对照研究和15项中断时间序列）符合我们的纳入标准，并被纳入审查。大多数研究是在美国的三级护理综合医院进行的，欧洲,和亚洲。11项研究包括在普通病房和重症监护病房住院的成年患者，其中一次是在新生儿重症监护室进行的，两个在血液科或肿瘤科，还有一个在实体器官移植科。在爆发的背景下进行了11项研究。关于使用的检测策略，所有研究均包括高危患者入院时的筛查策略,7项研究报告了接触监测策略.大多数研究是在同时安装或加强感染预防和控制措施的环境中进行的。数据不适合进行荟萃分析，所以结果被呈现为叙事综合。大多数研究表明，在实施积极监测政策后，感染率和定植率都有所下降，但CoE很低.筛查策略可能导致全因死亡率和住院时间的风险几乎没有差异。
结论：现有证据可能支持对碳青霉烯类耐药革兰阴性菌进行监测培养，但是它的质量很差，所以不能得出可靠的结论。需要进行良好的随机试验或高质量的准实验研究来提高现有证据的确定性。这些研究应评估添加筛查策略作为单一干预措施的效果，并测量临床上重要的结局，例如感染，住院时间,和死亡率。
