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Abstract：
BACKGROUND: Gut colonization with multidrug-resistant organisms (MDRO) frequently precedes infection among patients in the intensive care unit (ICU), although the dynamics of colonization are not completely understood. We performed a systematic review and meta-analysis of ICU studies which described the cumulative incidence and rates of MDRO gut acquisition.
METHODS: We systematically searched PubMed, Embase, and Web of Science for studies published from 2010 to 2023 reporting on gut acquisition of MDRO in the ICU. MDRO were defined as multidrug resistant non-Pseudomonas Gram-negative bacteria (NP-GN), Pseudomonas spp., and vancomycin-resistant Enterococcus (VRE). We included observational studies which obtained perianal or rectal swabs at ICU admission (within 48 h) and at one or more subsequent timepoints. Our primary outcome was the incidence rate of gut acquisition of MDRO, defined as any MDRO newly detected after ICU admission (i.e., not present at baseline) for all patient-time at risk. The study was registered with PROSPERO, CRD42023481569.
RESULTS: Of 482 studies initially identified, 14 studies with 37,305 patients met criteria for inclusion. The pooled incidence of gut acquisition of MDRO during ICU hospitalization was 5% (range: 1-43%) with a pooled incidence rate of 12.2 (95% CI 8.1-18.6) per 1000 patient-days. Median time to acquisition ranged from 4 to 26 days after ICU admission. Results were similar for NP-GN and Pseudomonas spp., with insufficient data to assess VRE. Among six studies which provided sufficient data to perform curve fitting, there was a quasi-linear increase in gut MDRO colonization of 1.41% per day which was stable through 30 days of ICU hospitalization (R2 = 0.50, p < 0.01).
CONCLUSIONS: Acquisition of gut MDRO was common in the ICU and increases with days spent in ICU through 30 days of follow-up. These data may guide future interventions seeking to prevent gut acquisition of MDRO in the ICU.
METHODS: We systematically searched PubMed, Embase, and Web of Science for studies published from 2010 to 2023 reporting on gut acquisition of MDRO in the ICU. MDRO were defined as multidrug resistant non-Pseudomonas Gram-negative bacteria (NP-GN), Pseudomonas spp., and vancomycin-resistant Enterococcus (VRE). We included observational studies which obtained perianal or rectal swabs at ICU admission (within 48 h) and at one or more subsequent timepoints. Our primary outcome was the incidence rate of gut acquisition of MDRO, defined as any MDRO newly detected after ICU admission (i.e., not present at baseline) for all patient-time at risk. The study was registered with PROSPERO, CRD42023481569.
RESULTS: Of 482 studies initially identified, 14 studies with 37,305 patients met criteria for inclusion. The pooled incidence of gut acquisition of MDRO during ICU hospitalization was 5% (range: 1-43%) with a pooled incidence rate of 12.2 (95% CI 8.1-18.6) per 1000 patient-days. Median time to acquisition ranged from 4 to 26 days after ICU admission. Results were similar for NP-GN and Pseudomonas spp., with insufficient data to assess VRE. Among six studies which provided sufficient data to perform curve fitting, there was a quasi-linear increase in gut MDRO colonization of 1.41% per day which was stable through 30 days of ICU hospitalization (R2 = 0.50, p < 0.01).
CONCLUSIONS: Acquisition of gut MDRO was common in the ICU and increases with days spent in ICU through 30 days of follow-up. These data may guide future interventions seeking to prevent gut acquisition of MDRO in the ICU.
摘要：
背景：多重耐药生物（MDRO）的肠道定植通常在重症监护病房（ICU）的患者中发生感染之前，虽然殖民的动力学还没有完全理解。我们对ICU研究进行了系统评价和荟萃分析，这些研究描述了MDRO肠道获取的累积发生率和发生率。
方法：我们系统地搜索了PubMed，Embase,和WebofScience于2010年至2023年发表的研究报告，报道了ICU中MDRO的肠道获取。MDRO被定义为多重耐药的非假单胞菌革兰氏阴性菌（NP-GN），假单胞菌属。,和耐万古霉素肠球菌(VRE)。我们纳入了观察性研究，这些研究在ICU入院时（48小时内）以及随后的一个或多个时间点获得了肛周或直肠拭子。我们的主要结果是MDRO的肠道获得性发生率，定义为ICU入院后新检测到的任何MDRO(即，基线时不存在)，适用于所有有风险的患者时间。这项研究在PROSPERO注册，CRD42023481569。
结果：在最初确定的482项研究中，14项研究，37,305名患者符合纳入标准。ICU住院期间肠道获取MDRO的合并发生率为5％（范围：1-43％），合并发生率为12.2（95％CI8.1-18.6）/1000患者天。ICU入院后的中位时间为4至26天。NP-GN和假单胞菌属的结果相似。,没有足够的数据来评估VRE。在提供足够数据进行曲线拟合的六项研究中，肠道MDRO定植呈每天1.41%的准线性增加,在ICU住院30天后保持稳定(R2=0.50,p<0.01)。
结论：获得肠道MDRO在ICU中很常见，并且随着30天随访在ICU中的天数增加。这些数据可能会指导未来的干预措施，以防止ICU中肠道获得MDRO。
方法：我们系统地搜索了PubMed，Embase,和WebofScience于2010年至2023年发表的研究报告，报道了ICU中MDRO的肠道获取。MDRO被定义为多重耐药的非假单胞菌革兰氏阴性菌（NP-GN），假单胞菌属。,和耐万古霉素肠球菌(VRE)。我们纳入了观察性研究，这些研究在ICU入院时（48小时内）以及随后的一个或多个时间点获得了肛周或直肠拭子。我们的主要结果是MDRO的肠道获得性发生率，定义为ICU入院后新检测到的任何MDRO(即，基线时不存在)，适用于所有有风险的患者时间。这项研究在PROSPERO注册，CRD42023481569。
结果：在最初确定的482项研究中，14项研究，37,305名患者符合纳入标准。ICU住院期间肠道获取MDRO的合并发生率为5％（范围：1-43％），合并发生率为12.2（95％CI8.1-18.6）/1000患者天。ICU入院后的中位时间为4至26天。NP-GN和假单胞菌属的结果相似。,没有足够的数据来评估VRE。在提供足够数据进行曲线拟合的六项研究中，肠道MDRO定植呈每天1.41%的准线性增加,在ICU住院30天后保持稳定(R2=0.50,p<0.01)。
结论：获得肠道MDRO在ICU中很常见，并且随着30天随访在ICU中的天数增加。这些数据可能会指导未来的干预措施，以防止ICU中肠道获得MDRO。
