Impact of carbapenem resistance on mortality in patients infected withEnterobacteriaceae: a systematic review and meta-analysis

Abstract

ObjectivesTo provide a comprehensive assessment of the impact of carbapenem resistance on mortality among patients infected with Enterobacteriaceae and to explore the source of heterogeneity across studies.DesignThis systematic review was conducted following the guidelines of Cochrane Guidance and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Data sourcesWe conducted a systematic literature search of the PubMed, Embase, Web of Science and Cochrane Library databases to identify relevant studies published between 1 January 1994 and 30 August 2020.Eligibility criteriaWe included primary observational studies published in English that reported the mortality outcomes for hospitalised patients with confirmed infections due to carbapenem-resistant Enterobacteriaceae (CRE) and carbapenem-susceptible Enterobacteriaceae (CSE). Studies with no comparison group or with a comparison group of patients infected with unconfirmed CSE were excluded.Data extraction and synthesisData extraction and assessment of risk bias were conducted independently by two reviewers. The pooled relative risk and risk difference were calculated as effect measures with 95% CIs using a random effects model. The heterogeneity across studies was assessed by Q-statistic and I2 measures.ResultsOf 10 304 studies initially identified, 50 studies were included in the meta-analyses. The results of the meta-analyses showed that carbapenem resistance has a significant positive effect on the probability of death for patients infected with Enterobacteriaceae for any type of mortality outcome. The results of the stratified analysis and meta-regression suggested that the effect of carbapenem resistance on the risk of death varied by infection type, sample size and year of publication.ConclusionsOur results suggested that patients with CRE infection still face a greater risk of death than patients with CSE infection do, and an urgent need to develop new antibiotics and appropriate treatments to reduce the risk of death.PROSPERO registration numberCRD42020176808.

Risk Factors for Mortality and Antimicrobial Regimens in Pediatric Intensive Care Unit Patients with Carbapenem-Resistant Enterobacteriaceae Infections: A Six-Year Retrospective Study

“…The overall 30-day mortality of PICU patients with CRE infections was 50% and the most frequently isolated pathogen was K. pneumoniae (n=37, 66.1%), which was consistent with previous domestic and 7312 international epidemiologic data. [3][4][5][6][7][8]20 In this study, hematological system disease, PCIS, serum albumin, platelet count, serum creatinine, and C-reactive protein were associated with mortality (Table 1). While only PCIS and serum albumin levels were the independent mortality-related risk factors in the Cox regression analysis (Figure 2).…”

“…1,2 Multi-drug resistance profile of CRE leads to considerable mortality. The overall 30-day mortality of CRE infections is approximately 30-50% in adult patients, [3][4][5] and as high as 52% in children. [6][7][8] Several factors such as immunocompromised status, sepsis/septic shock, and neutropenia have been reported to be significant risk factors for 30-day mortality in adult patients with CRE infection.…”

Triple quadrupole LC/MS method for the simultaneous quantitative measurement of cefiderocol and meropenem in serum

“…CP-CRE is associated with mortality rates as high as 50%, posing a signicant global threat to modern medicine. 10 CP-CRE have been categorised by the World Health Organisation as critical priority pathogens for discovery, research, and development of new antibiotics. 11 Cederocol is a siderophore cephalosporin with a novel side chain that facilitates entry into cells.…”

Can precision antibiotic prescribing help prevent the spread of carbapenem-resistant organisms in the hospital setting?

“… 1 Mortality following CRO infection is up to 50%, largely due to the limited treatment options. 4 Consequently, they have been categorized by the WHO as critical priority pathogens for discovery, research and development of new antibiotics. 5 …”