Sainfer Aliyu1, Arlene Smaldone2, Elaine Larson3. 1. Columbia University School of Nursing, New York, NY. Electronic address: sea2157@cumc.columbia.edu. 2. Columbia University School of Nursing, New York, NY. 3. Columbia University School of Nursing, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
Abstract
BACKGROUND: Multidrug-resistant gram-negative bacteria (MDR-GNB) are associated with an increasing proportion of infections among nursing home (NH) residents. The objective of this systematic review and meta-analysis was to critically review evidence of the prevalence of MDR-GNB among NH residents. METHODS: Following Meta-Analysis of Observational Studies in Epidemiology guidelines, a systematic review of literature for the years 2005-2016 using multiple databases was conducted. Study quality, appraised by 2 reviewers, used Downs and Black risk of bias criteria. Studies reporting prevalence of MDR-GNB colonization were pooled using a random effects meta-analysis model. Heterogeneity was assessed using Cochran Q and I2 statistics. RESULTS: Of 327 articles, 12 met the criteria for review; of these, 8 met the criteria for meta-analysis. Escherichia coli accounted for the largest proportion of isolates. Reported MDR-GNB colonization prevalence ranged from 11.2%-59.1%. Pooled prevalence for MDR-GNB colonization, representing data from 2,720 NH residents, was 27% (95% confidence interval, 15.2%-44.1%) with heterogeneity (Q = 405.6; P = .01; I2 = 98.3). Two studies reported MDR-GNB infection rates of 10.9% and 62.7%. CONCLUSION: Our findings suggest a high prevalence of MDR-GNB colonization among NH residents, emphasizing the need to enhance policies for infection control and prevention (ICP) in NHs.
BACKGROUND: Multidrug-resistant gram-negative bacteria (MDR-GNB) are associated with an increasing proportion of infections among nursing home (NH) residents. The objective of this systematic review and meta-analysis was to critically review evidence of the prevalence of MDR-GNB among NH residents. METHODS: Following Meta-Analysis of Observational Studies in Epidemiology guidelines, a systematic review of literature for the years 2005-2016 using multiple databases was conducted. Study quality, appraised by 2 reviewers, used Downs and Black risk of bias criteria. Studies reporting prevalence of MDR-GNB colonization were pooled using a random effects meta-analysis model. Heterogeneity was assessed using Cochran Q and I2 statistics. RESULTS: Of 327 articles, 12 met the criteria for review; of these, 8 met the criteria for meta-analysis. Escherichia coli accounted for the largest proportion of isolates. Reported MDR-GNB colonization prevalence ranged from 11.2%-59.1%. Pooled prevalence for MDR-GNB colonization, representing data from 2,720 NH residents, was 27% (95% confidence interval, 15.2%-44.1%) with heterogeneity (Q = 405.6; P = .01; I2 = 98.3). Two studies reported MDR-GNB infection rates of 10.9% and 62.7%. CONCLUSION: Our findings suggest a high prevalence of MDR-GNB colonization among NH residents, emphasizing the need to enhance policies for infection control and prevention (ICP) in NHs.
Authors: James A McKinnell; Loren G Miller; Raveena D Singh; Gabrielle Gussin; Ken Kleinman; Job Mendez; Bryn Laurner; Tabitha D Catuna; Lauren Heim; Raheeb Saavedra; James Felix; Crystal Torres; Justin Chang; Marlene Estevez; Joanna Mendez; Gregory Tchakalian; Leah Bloomfield; Sandra Ceja; Ryan Franco; Aaron Miner; Aura Hurtado; Ratharo Hean; Alex Varasteh; Philip A Robinson; Steven Park; Steven Tam; Thomas Tjoa; Jiayi He; Shalini Agrawal; Stacey Yamaguchi; Harold Custodio; Jenny Nguyen; Cassiana E Bittencourt; Kaye D Evans; Vincent Mor; Kevin McConeghy; Robert A Weinstein; Mary K Hayden; Nimalie D Stone; Karl Steinberg; Nancy Beecham; Jocelyn Montgomery; Walters DeAnn; Ellena M Peterson; Susan S Huang Journal: J Am Med Dir Assoc Date: 2020-06-16 Impact factor: 4.669
Authors: Patricia W Stone; Carolyn T A Herzig; Mansi Agarwal; Monika Pogorzelska-Maziarz; Andrew W Dick Journal: Inquiry Date: 2018 Jan-Dec Impact factor: 1.730