Sanjay Merchant1, Emma M Proudfoot2, Hafsa N Quadri2, Heather J McElroy3, William R Wright4, Ankur Gupta5, Eric M Sarpong6. 1. Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033-1310, USA. Electronic address: sanjay.merchant@merck.com. 2. Covance Market Access Services Inc., 3rd Floor, 97 Waterloo Rd, Macquarie Park, NSW 2113, Australia. 3. Covance (Asia) Pte Ltd., 1 International Business Park, #01-01 The Synergy, 609917, Singapore. 4. Covance Market Access Services Inc., 4 Maguire Street, Butlers Wharf, London SE1 2NQ, UK. 5. MSD Pharmaceuticals Pvt. Ltd., 6th Floor, Vatika Towers(B), Sector-54, Gurgaon 122 002, India. 6. Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033-1310, USA.
Abstract
OBJECTIVES: Treating infections of Gram-negative pathogens, in particular Pseudomonas aeruginosa, is a challenge for clinicians in the Asia-Pacific region owing to inherent and acquired antimicrobial resistance. This systematic review and meta-analysis provides updated information on risk factors for P. aeruginosa infection in Asia-Pacific as well as the consequences (e.g. mortality, costs) of initial inappropriate antimicrobial therapy (IIAT). METHODS: Embase and MEDLINE databases were searched for Asia-Pacific studies reporting the consequences of IIAT versus initial appropriate antimicrobial therapy (IAAT) in Gram-negative bacterial infections as well as risk factors for serious P. aeruginosa infection. A meta-analysis of unadjusted mortality was performed using a random-effects model. RESULTS: A total of 22 studies reporting mortality and 13 reporting risk factors were identified. The meta-analysis demonstrated that mortality was significantly lower in patients receiving IAAT versus IIAT, with a 67% reduction observed for 28- or 30-day all-cause mortality (odds ratio=0.33, 95% confidence interval 0.20-0.55; P<0.001). Risk factors for serious P. aeruginosa infection include previous exposure to antimicrobials, mechanical ventilation and previous hospitalisation. CONCLUSION: High rates of antimicrobial resistance in Asia-Pacific as well as the increased mortality associated with IIAT and the presence of risk factors for serious infection highlight the importance of access to newer and appropriate antimicrobials.
OBJECTIVES: Treating infections of Gram-negative pathogens, in particular Pseudomonas aeruginosa, is a challenge for clinicians in the Asia-Pacific region owing to inherent and acquired antimicrobial resistance. This systematic review and meta-analysis provides updated information on risk factors for P. aeruginosa infection in Asia-Pacific as well as the consequences (e.g. mortality, costs) of initial inappropriate antimicrobial therapy (IIAT). METHODS: Embase and MEDLINE databases were searched for Asia-Pacific studies reporting the consequences of IIAT versus initial appropriate antimicrobial therapy (IAAT) in Gram-negative bacterial infections as well as risk factors for serious P. aeruginosa infection. A meta-analysis of unadjusted mortality was performed using a random-effects model. RESULTS: A total of 22 studies reporting mortality and 13 reporting risk factors were identified. The meta-analysis demonstrated that mortality was significantly lower in patients receiving IAAT versus IIAT, with a 67% reduction observed for 28- or 30-day all-cause mortality (odds ratio=0.33, 95% confidence interval 0.20-0.55; P<0.001). Risk factors for serious P. aeruginosa infection include previous exposure to antimicrobials, mechanical ventilation and previous hospitalisation. CONCLUSION: High rates of antimicrobial resistance in Asia-Pacific as well as the increased mortality associated with IIAT and the presence of risk factors for serious infection highlight the importance of access to newer and appropriate antimicrobials.
Authors: Jin Suk Kang; Chisook Moon; Seok Jun Mun; Jeong Eun Lee; Soon Ok Lee; Shinwon Lee; Sun Hee Lee Journal: J Korean Med Sci Date: 2021-11-08 Impact factor: 2.153