Weiping Ling1, Luis Furuya-Kanamori1, Yukiko Ezure1, Patrick N A Harris1,2, David L Paterson1,3. 1. Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland, Herston, Brisbane, Australia. 2. Central Microbiology, Pathology Queensland, Royal Brisbane & Women's Hospital, Herston, Brisbane, Australia. 3. Herston Infectious Diseases Institute (HeIDI), Brisbane, Australia.
Abstract
OBJECTIVES: Enterobacterales producing ESBL (ESBL-E) have been notable for their rapid expansion in community settings. This systematic review and meta-analysis aimed to summarize evidence investigating the association between ESBL-E infection and adverse clinical outcomes, defined as bacteraemia, sepsis or septic shock, and all-cause mortality in adult patients. METHODS: Database search was conducted in PubMed, Scopus and EMBASE. In general, studies were screened for effect estimates of ESBL-E colonization or infection on clinical outcomes with non-ESBL-producing Enterobacterales as comparator, adult populations and molecular ascertainment of ESBL gene. Meta-analysis was performed using the inverse variance heterogeneity model. RESULTS: Eighteen studies were identified, including 1399 ESBL-E and 3200 non-ESBL-E infected patients. Sixteen of these studies included only bacteraemic patients. Mortality was studied in 17 studies and ESBL-E infection was significantly associated with higher odds of mortality compared with non-ESBL-producing Enterobacterales infection (OR = 1.70, 95% CI: 1.15-2.49, I 2=58.3%). However, statistical significance did not persist when adjusted estimates were pooled (aOR = 1.67, 95% CI: 0.52-5.39, I 2=78.1%). Septic shock was studied in seven studies and all included only bacteraemic patients. No association between ESBL-E infection and shock was found (OR = 1.23, 95% CI: 0.75-2.02, I 2=14.8%). Only one study investigated the association between ESBL-E infection and bacteraemia. CONCLUSIONS: Infections by ESBL-E appear to be significantly associated with mortality but not septic shock. Available studies investigating bacteraemia and shock as an intermediate outcome of ESBL-E infections are lacking. Future studies investigating the relationship between clinical outcomes and molecular characteristics of resistant strains are further warranted, along with studies investigating this in non-bacteraemic patients.
OBJECTIVES: Enterobacterales producing ESBL (ESBL-E) have been notable for their rapid expansion in community settings. This systematic review and meta-analysis aimed to summarize evidence investigating the association between ESBL-E infection and adverse clinical outcomes, defined as bacteraemia, sepsis or septic shock, and all-cause mortality in adult patients. METHODS: Database search was conducted in PubMed, Scopus and EMBASE. In general, studies were screened for effect estimates of ESBL-E colonization or infection on clinical outcomes with non-ESBL-producing Enterobacterales as comparator, adult populations and molecular ascertainment of ESBL gene. Meta-analysis was performed using the inverse variance heterogeneity model. RESULTS: Eighteen studies were identified, including 1399 ESBL-E and 3200 non-ESBL-E infected patients. Sixteen of these studies included only bacteraemic patients. Mortality was studied in 17 studies and ESBL-E infection was significantly associated with higher odds of mortality compared with non-ESBL-producing Enterobacterales infection (OR = 1.70, 95% CI: 1.15-2.49, I 2=58.3%). However, statistical significance did not persist when adjusted estimates were pooled (aOR = 1.67, 95% CI: 0.52-5.39, I 2=78.1%). Septic shock was studied in seven studies and all included only bacteraemic patients. No association between ESBL-E infection and shock was found (OR = 1.23, 95% CI: 0.75-2.02, I 2=14.8%). Only one study investigated the association between ESBL-E infection and bacteraemia. CONCLUSIONS: Infections by ESBL-E appear to be significantly associated with mortality but not septic shock. Available studies investigating bacteraemia and shock as an intermediate outcome of ESBL-E infections are lacking. Future studies investigating the relationship between clinical outcomes and molecular characteristics of resistant strains are further warranted, along with studies investigating this in non-bacteraemic patients.
Authors: Young Eun Ha; Cheol-In Kang; Min Kyeong Cha; So Yeon Park; Yu Mi Wi; Doo Ryeon Chung; Kyong Ran Peck; Nam Yong Lee; Jae-Hoon Song Journal: Int J Antimicrob Agents Date: 2013-09-07 Impact factor: 5.283
Authors: Matthew E Falagas; Giannoula S Tansarli; Drosos E Karageorgopoulos; Konstantinos Z Vardakas Journal: Emerg Infect Dis Date: 2014-07 Impact factor: 6.883
Authors: Jin Young Ahn; Hea Won Ann; Yongduk Jeon; Mi Young Ahn; Dong Hyun Oh; Yong Chan Kim; Eun Jin Kim; Je Eun Song; In Young Jung; Moo Hyun Kim; Wooyoung Jeong; Nam Su Ku; Su Jin Jeong; Jun Yong Choi; Dongeun Yong; Young Goo Song; June Myung Kim Journal: BMC Infect Dis Date: 2017-05-03 Impact factor: 3.090