{Reference Type}: Meta-Analysis
{Title}: A systematic review on the excess health risk of antibiotic-resistant bloodstream infections for six key pathogens in Europe.
{Author}: Hassoun-Kheir N;Guedes M;Ngo Nsoga MT;Argante L;Arieti F;Gladstone BP;Kingston R;Naylor NR;Pezzani MD;Pouwels KB;Robotham JV;Rodríguez-Baño J;Tacconelli E;Vella V;Harbarth S;de Kraker MEA; ;
{Journal}: Clin Microbiol Infect
{Volume}: 30
{Issue}: 0
{Year}: 2024 Mar
{Factor}: 13.31
{DOI}: 10.1016/j.cmi.2023.09.001
{Abstract}: <B>BACKGROUND: </B>Antimicrobial resistance is a global threat, which requires novel intervention strategies, for which priority pathogens and settings need to be determined.<BR><B>OBJECTIVE: </B>We evaluated pathogen-specific excess health burden of drug-resistant bloodstream infections (BSIs) in Europe.<BR><B>METHODS: </B>A systematic review and meta-analysis.<BR><B>METHODS: </B>MEDLINE, Embase, and grey literature for the period January 1990 to May 2022.<BR><B>METHODS: </B>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.<BR><B>METHODS: </B>Paediatric and adult patients diagnosed with drug-resistant BSI.<BR><B>METHODS: </B>Not applicable.<BR><B>UNASSIGNED: </B>An adapted version of the Joanna-Briggs Institute assessment tool.<BR><B>UNASSIGNED: </B>Random-effect models were used to pool pathogen-specific burden estimates.<BR><B>RESULTS: </B>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).<BR><B>CONCLUSIONS: </B>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.