Risk Factors of Multidrug-Resistant Bacteria in Lower Respiratory Tract Infections: A Systematic Review and Meta-Analysis

Abstract

Background. Multidrug-resistant (MDR) bacteria are the main cause of lower respiratory tract infections (LRTIs) with high mortality. The purpose of this study is to identify the risk factors associated with MDR by performing a systematic review and meta-analysis. Methods. PubMed, EMBASE (via Ovid), and Cochrane Library were systematically searched for studies on the risk factors for MDR bacteria in LRTIs as of November 30, 2019. Literature screening, data abstraction, and quality assessment of the eligible studies were performed independently by two researchers. Results. A total of 3,607 articles were retrieved, of which 21 articles representing 20 cohort studies published in English were included after title/abstract and full-text screening. Among the 21 articles involving 7,650 patients and 1,360 MDR organisms, ten reported the risk factors for MDR Gram-positive bacteria (GPB) and Gram-negative bacteria (GNB), ten for MDR GNB, and one for MDR GPB. The meta-analysis results suggested that prior antibiotic treatment, inappropriate antibiotic therapy, chronic lung disease, chronic liver disease and cerebral disease, prior MDR and PA infection/colonization, recent hospitalization, longer hospitalization stay, endotracheal tracheostomy and mechanical ventilation, tube feeding, nursing home residence, and higher disease severity score were independent risk factors for MDR bacteria. Conclusions. This review identified fourteen clinical factors that might increase the risk of MDR bacteria in patients with LRTIs. Clinicians could take into account these factors when selecting antibiotics for patients and determine whether coverage for MDR bacteria is required. More well-designed studies are needed to confirm the various risk factors for MDR bacteria in the future.

Multi-drug resistant gram-negative bacterial pneumonia: etiology, risk factors, and drug resistance patterns

“…Even though S. pneumoniae is the most prevalent cause of CAP in all age groups around the world, gram-negative bacteria (GNB) such as K. pneumoniae, Acinetobacter baumannii, P. aeruginosa, and E. coli are commonly related to HAP [ 3 , 16 , 17 ]. Antibiotic resistance is increasingly being recognized as a major worldwide health concern resulting from antibiotic overuse and improper administration [ 18 ]. Nowadays, pneumonia caused by multidrug-resistant gram-negative bacteria (MDR-GNB) is growing more common and has a detrimental impact on patient outcomes, indicating a shift in infection trends to GNB and their rapid dissemination, particularly in the hospital settings [ 19 – 23 ].…”

Evaluation of the BioFire FilmArray Pneumonia Panel Plus to the Conventional Diagnostic Methods in Determining the Microbiological Etiology of Hospital-Acquired Pneumonia

“…In addition to the associated morbidity and high finical burden within hospital settings, the microbiological diagnosis of HAP/VAP remains challenging. Of concern, the difficulty in obtaining a reliable LRT specimen by non-invasive techniques [6], the wide range of microbial profiles (bacteria, virus, or, rarely, fungi) [7], the escalating threats of multidrugresistant (MDR) bacteria, and the long turnaround time of about 2-3 days to obtain culture results further complicated the ability to diagnose by conventional means [8,9]. However, microbiological methods are necessary in guiding empiric antibiotic regimens and prescribing appropriate treatment [10].…”

Airway Multidrug-Resistant Organisms in a Population of Tracheostomy and Chronic Ventilator-Dependent Children at a Tertiary Care Pediatric Hospital

“…We had a higher rate of MDROs in our patient population compared to other studies of tracheostomy and ventilation-dependent children 15 . 76% of our participants had at least one respiratory tract culture with a MDRO.…”

“…We found that frequent hospitalizations and antibiotic usage increased the risk of MDRO in the respiratory tract of technology-dependent children. It has been shown that hospitalizations and prior antibiotic usage were independent risk factors for lower respiratory tract MDROs in adults, but has not been well described in children 15 . We also found that both intermittent antibiotic usage and chronic antibiotics increased risk of MDRO.…”

“…Tracheostomy and ventilator-dependent children are frequently prescribed broad spectrum empiric antibiotics for illnesses 7; 11; 12 . Frequent and prolonged use of antibiotics is associated with emergence of antibiotic resistance in numerous patient populations [13][14][15] , but there is a paucity of data specific to tracheostomy and ventilator-dependent children. Our study found that increased antibiotic usage and episodes of hospitalization put these patients at risk of MDROs.…”