Dalton R Budhram1, Stephen Mac2,3, Joanna M Bielecki3, Samir N Patel4,5, Beate Sander2,3,4,6. 1. Department of Medicine, Queen's University, Kingston, Ontario, Canada. 2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 3. Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada. 4. Public Health Ontario Laboratory, Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada. 5. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. 6. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) pose a significant global health threat. OBJECTIVE: To conduct a systematic review of health outcomes and long-term sequelae attributable to CPE infection. METHODS: We followed PRISMA reporting guidelines and published our review protocol on PROSPERO (CRD42018097357). We searched Medline, Embase, CINAHL and the Cochrane Library. We included primary studies with a carbapenem-susceptible control group in high-income countries, published in English. Quality appraisal was completed using Joanna Briggs Institute checklists. We qualitatively summarized frequently reported outcomes and conducted a meta-analysis. RESULTS: Our systematic review identified 8,671 studies; 17 met the eligibility criteria for inclusion. All studies reported health outcomes; none reported health-related quality-of-life. Most studies were from Europe (65%), were conducted in teaching or university-affiliated hospitals (76%), and used case-control designs (53%). Mortality was the most commonly reported consequence of CPE-infections; in-hospital mortality was most often reported (62%). Our meta-analysis (n = 5 studies) estimated an absolute risk difference (ARD) for in-hospital bloodstream infection mortality of 0.25 (95% confidence interval [CI], 0.17-0.32). Duration of antibiotic therapy (range, 4-29.7 vs 1-23.6 days) and length of hospital stay (range, 21-87 vs 15-43 days) were relatively higher for CPE-infected patients than for patients infected with carbapenem-susceptible pathogens. Most studies (82%) met >80% of their respective quality appraisal criteria. CONCLUSIONS: The risk of in-hospital mortality due to CPE bloodstream infection is considerably greater than carbapenem-susceptible bloodstream infection (ARD, 0.25; 95% CI, 0.17-0.32). Health outcome studies associated with CPE infection are focused on short-term (eg, in-hospital) outcomes; long-term sequelae and quality-of-life are not well studied. TRIAL REGISTRATION: PROSPERO (CRD42018097357).
BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) pose a significant global health threat. OBJECTIVE: To conduct a systematic review of health outcomes and long-term sequelae attributable to CPE infection. METHODS: We followed PRISMA reporting guidelines and published our review protocol on PROSPERO (CRD42018097357). We searched Medline, Embase, CINAHL and the Cochrane Library. We included primary studies with a carbapenem-susceptible control group in high-income countries, published in English. Quality appraisal was completed using Joanna Briggs Institute checklists. We qualitatively summarized frequently reported outcomes and conducted a meta-analysis. RESULTS: Our systematic review identified 8,671 studies; 17 met the eligibility criteria for inclusion. All studies reported health outcomes; none reported health-related quality-of-life. Most studies were from Europe (65%), were conducted in teaching or university-affiliated hospitals (76%), and used case-control designs (53%). Mortality was the most commonly reported consequence of CPE-infections; in-hospital mortality was most often reported (62%). Our meta-analysis (n = 5 studies) estimated an absolute risk difference (ARD) for in-hospital bloodstream infection mortality of 0.25 (95% confidence interval [CI], 0.17-0.32). Duration of antibiotic therapy (range, 4-29.7 vs 1-23.6 days) and length of hospital stay (range, 21-87 vs 15-43 days) were relatively higher for CPE-infected patients than for patients infected with carbapenem-susceptible pathogens. Most studies (82%) met >80% of their respective quality appraisal criteria. CONCLUSIONS: The risk of in-hospital mortality due to CPE bloodstream infection is considerably greater than carbapenem-susceptible bloodstream infection (ARD, 0.25; 95% CI, 0.17-0.32). Health outcome studies associated with CPE infection are focused on short-term (eg, in-hospital) outcomes; long-term sequelae and quality-of-life are not well studied. TRIAL REGISTRATION: PROSPERO (CRD42018097357).
Authors: Daloha Rodríguez-Molina; Fanny Berglund; Hetty Blaak; Carl-Fredrik Flach; Merel Kemper; Luminita Marutescu; Gratiela Pircalabioru Gradisteanu; Marcela Popa; Beate Spießberger; Laura Wengenroth; Mariana Carmen Chifiriuc; D G Joakim Larsson; Dennis Nowak; Katja Radon; Ana Maria de Roda Husman; Andreas Wieser; Heike Schmitt Journal: Int J Environ Res Public Health Date: 2022-04-14 Impact factor: 4.614
Authors: Courtney R Lane; Judith Brett; Mark Schultz; Claire L Gorrie; Kerrie Stevens; Donna R M Cameron; Siobhan St George; Annaliese van Diemen; Marion Easton; Rhonda L Stuart; Michelle Sait; Anton Y Peleg; Andrew J Stewardson; Allen C Cheng; Denis W Spelman; Mary Jo Waters; Susan A Ballard; Norelle L Sherry; Deborah A Williamson; Finn Romanes; Brett Sutton; Jason C Kwong; Torsten Seemann; Anders Goncalves da Silva; Nicola Stephens; Benjamin P Howden Journal: Clin Infect Dis Date: 2021-12-06 Impact factor: 9.079