OBJECTIVE: We evaluated pathogen-specific excess health burden of drug-resistant bloodstream infections (BSIs) in Europe.
METHODS: A systematic review and meta-analysis.
METHODS: MEDLINE, Embase, and grey literature for the period January 1990 to May 2022.
METHODS: Studies that reported burden data for six key drug-resistant pathogens: carbapenem-resistant (CR) Pseudomonas aeruginosa and Acinetobacter baumannii, third-generation cephalosporin or CR Escherichia coli and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium. Excess health outcomes compared with drug-susceptible BSIs or uninfected patients. For MRSA and third-generation cephalosporin E. coli and K. pneumoniae BSIs, five or more European studies were identified. For all others, the search was extended to high-income countries.
METHODS: Paediatric and adult patients diagnosed with drug-resistant BSI.
METHODS: Not applicable.
UNASSIGNED: An adapted version of the Joanna-Briggs Institute assessment tool.
UNASSIGNED: Random-effect models were used to pool pathogen-specific burden estimates.
RESULTS: We screened 7154 titles, 1078 full-texts and found 56 studies on BSIs. Most studies compared outcomes of drug-resistant to drug-susceptible BSIs (46/56, 82.1%), and reported mortality (55/56 studies, 98.6%). The pooled crude estimate for excess all-cause mortality of drug-resistant versus drug-susceptible BSIs ranged from OR 1.31 (95% CI 1.03-1.68) for CR P. aeruginosa to OR 3.44 (95% CI 1.62-7.32) for CR K. pneumoniae. Pooled crude estimates comparing mortality to uninfected patients were available for vancomycin-resistant Enterococcus and MRSA BSIs (OR of 11.19 [95% CI 6.92-18.09] and OR 6.18 [95% CI 2.10-18.17], respectively).
CONCLUSIONS: Drug-resistant BSIs are associated with increased mortality, with the magnitude of the effect influenced by pathogen type and comparator. Future research should address crucial knowledge gaps in pathogen- and infection-specific burdens to guide development of novel interventions.
目的:我们评估了欧洲耐药血流感染(BSIs)的病原体特异性超额健康负担。
方法:系统综述和荟萃分析。
方法:MEDLINE,Embase,1990年1月至2022年5月期间的灰色文献。
方法:研究报告了六种关键耐药病原体的负担数据:耐碳青霉烯(CR)铜绿假单胞菌和鲍曼不动杆菌,第三代头孢菌素或CR大肠杆菌和肺炎克雷伯菌,耐甲氧西林金黄色葡萄球菌(MRSA)和耐万古霉素屎肠球菌。与药物敏感的BSI或未感染患者相比,健康结果过多。对于MRSA和第三代头孢菌素大肠杆菌和肺炎克雷伯菌BSIs,确定了五项或更多的欧洲研究。对于所有其他人,搜索扩展到高收入国家。
方法:诊断为耐药BSI的儿科和成年患者。
方法:不适用。
■乔安娜-布里格斯研究所评估工具的改编版本。
■随机效应模型用于汇集病原体特异性负荷估计。
结果:我们筛选了7154个标题,1078个全文,发现56个关于BSIs的研究。大多数研究比较了耐药与药物敏感BSI的结果(46/56,82.1%),和报告的死亡率(55/56研究,98.6%)。耐药与敏感的BSI的全因死亡率的汇总粗估计值从CR铜绿假单胞菌的OR1.31(95%CI1.03-1.68)到CR肺炎克雷伯菌的OR3.44(95%CI1.62-7.32)。对万古霉素耐药肠球菌和MRSABSI的死亡率与未感染患者的死亡率进行汇总的粗略估计(OR为11.19[95%CI6.92-18.09]和OR为6.18[95%CI2.10-18.17],分别)。
结论:耐药BSI与死亡率增加相关,影响的大小受病原体类型和比较物的影响。未来的研究应解决病原体和感染特异性负担中的关键知识差距,以指导新型干预措施的开发。