Clinical and economic consequences of hospital-acquired resistant and multidrug-resistant Pseudomonas aeruginosa infections: a systematic review and meta-analysis.
Clinical and economic consequences of hospital-acquired resistant and multidrug-resistant Pseudomonas aeruginosa infections: a systematic review and meta-analysis.
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DOI：
10.1186/2047-2994-3-32
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发表时间：
2014
影响因子：
5.5
通讯作者：
Menon V
中科院分区：
文献类型：
--
作者：
Nathwani D;Raman G;Sulham K;Gavaghan M;Menon V
住院患者中耐药和多药耐药（MDR）铜绿假单胞菌的比例增加构成了主要的公共卫生威胁。我们提出了一个系统的审查，这种耐药病原体的临床和经济影响。纳入了2000年1月至2013年2月期间MEDLINE和科克伦数据库中检索的研究，这些研究报告了至少20例实验室确认耐药铜绿假单胞菌感染的住院患者的全因死亡率、住院时间、住院费用、再入院或复发。我们接受了MDR的个体研究定义，并评估了研究方法学质量。MDR最常见的定义是对三种或三种以上抗生素中的一种以上的药物耐药。分析了23项研究（7，881例易感铜绿假单胞菌患者，1，653例耐药铜绿假单胞菌患者，559例MDR铜绿假单胞菌患者，387例未感染铜绿假单胞菌的患者）。随机效应模型荟萃分析对于全因住院死亡率终点是可行的。任何耐药铜绿假单胞菌患者的全因死亡率为34%（95%置信区间（CI）27% - 41%），而敏感铜绿假单胞菌患者的全因死亡率为22%（95% CI 14% - 29%）。荟萃分析表明，与敏感铜绿假单胞菌相比，MDR铜绿假单胞菌的死亡风险增加> 2倍（相对风险（RR）2.34，95% CI 1.53 - 3.57），耐药铜绿假单胞菌的风险增加24%（RR 1.24，95% CI 1.11 - 1.38）。对7项研究的数据进行的调整后荟萃分析表明，任何耐药铜绿假单胞菌患者的死亡风险增加无统计学意义（调整后RR 1.24，95% CI 0.98 - 1.57）。所有三项报告感染相关死亡率的研究都发现，与易感铜绿假单胞菌患者相比，MDR铜绿假单胞菌患者的风险在统计学上显著增加。在所有研究中，耐药和MDR铜绿假单胞菌感染患者的住院时间（LOS）高于易感铜绿假单胞菌和对照患者。局限性包括MDR定义的异质性、仅限于院内感染和分析中的潜在混杂因素。耐药和MDR铜绿假单胞菌感染的住院患者似乎增加了全因死亡率和LOS。这些病原体的负面临床和经济影响值得深入评价最佳感染预防和管理策略。本文的在线版本（doi：10.1186/2047-2994-3-32）包含补充材料，可供授权用户使用。
Increasing rates of resistant and multidrug-resistant (MDR) P. aeruginosa in hospitalized patients constitute a major public health threat. We present a systematic review of the clinical and economic impact of this resistant pathogen. Studies indexed in MEDLINE and Cochrane databases between January 2000-February 2013, and reported all-cause mortality, length of stay, hospital costs, readmission, or recurrence in at least 20 hospitalized patients with laboratory confirmed resistant P. aeruginosa infection were included. We accepted individual study definitions of MDR, and assessed study methodological quality. The most common definition of MDR was resistance to more than one agent in three or more categories of antibiotics. Twenty-three studies (7,881 patients with susceptible P. aeruginosa, 1,653 with resistant P. aeruginosa, 559 with MDR P. aeruginosa, 387 non-infected patients without P. aeruginosa) were analyzed. A random effects model meta-analysis was feasible for the endpoint of all-cause in-hospital mortality. All-cause mortality was 34% (95% confidence interval (CI) 27% – 41%) in patients with any resistant P. aeruginosa compared to 22% (95% CI 14% – 29%) with susceptible P. aeruginosa. The meta-analysis demonstrated a > 2-fold increased risk of mortality with MDR P. aeruginosa (relative risk (RR) 2.34, 95% CI 1.53 – 3.57) and a 24% increased risk with resistant P. aeruginosa (RR 1.24, 95% CI 1.11 – 1.38), compared to susceptible P. aeruginosa. An adjusted meta-analysis of data from seven studies demonstrated a statistically non-significant increased risk of mortality in patients with any resistant P. aeruginosa (adjusted RR 1.24, 95% CI 0.98 – 1.57). All three studies that reported infection-related mortality found a statistically significantly increased risk in patients with MDR P. aeruginosa compared to those with susceptible P. aeruginosa. Across studies, hospital length of stay (LOS) was higher in patients with resistant and MDR P. aeruginosa infections, compared to susceptible P. aeruginosa and control patients. Limitations included heterogeneity in MDR definition, restriction to nosocomial infections, and potential confounding in analyses. Hospitalized patients with resistant and MDR P. aeruginosa infections appear to have increased all-cause mortality and LOS. The negative clinical and economic impact of these pathogens warrants in-depth evaluation of optimal infection prevention and stewardship strategies. The online version of this article (doi:10.1186/2047-2994-3-32) contains supplementary material, which is available to authorized users.
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影响因子：
38.9
作者：
Dupont, H;Montravers, P;Martin, C
通讯作者：
Martin, C
影响因子：
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作者：
Carmeli, Y;Troillet, N;Samore, MH
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影响因子：
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作者：
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影响因子：
11.8
作者：
Boucher, Helen W.;Talbot, George H.;Bartlett, John
通讯作者：
Bartlett, John
影响因子：
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作者：
Chatzinikolaou, I;Abi-Said, D;Samonis, G
通讯作者：
Samonis, G