Revisión sistemática de la literatura y análisis de expertos sobre los factores de riesgo asociados a infecciones causadas por Pseudomonas aeruginosa o Acinetobacter baumannii resistentes a carbapenémicos en pacientes adultos en España Translated title: A systematic review and expert’s analysis of risk factors of infections in adults due to carbapenem-resistant Pseudomonas aeruginosa or Acinetobacter baumannii in Spain

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RESUMEN

Objetivo

El objetivo del estudio es identificar los factores de riesgo asociados a infecciones por Pseudomonas aeruginosa resistente a antibióticos carbapenémicos (PARC) y Acinetobacter baumannii resistente a antibióticos carbapenémicos (ABRC) en pacientes adultos a través de una revisión sistemática de la literatura, clasificarlos según su nivel de importancia y exponer las recomendaciones en el entorno español de un panel de expertos.

Material y métodos

Se llevó a cabo una revisión sistemática de la literatura para identificar los factores de riesgo asociados a PARC o ABRC y posteriormente evaluar cada factor de riesgo por un panel de expertos basándose en la evidencia disponible y su experiencia en la práctica clínica.

Resultados

Se identificaron 593 artículos incluyéndose 29 para PARC y 23 para ABRC. Se identificaron 38 factores de riesgo asociados a PARC y 36 factores de riesgo asociados a ABRC. Tras su evaluación, para PARC, se clasificaron en: 11 importantes, 10 moderadamente importantes y 15 poco importantes; y para ABRC, 9 importantes, 5 moderadamente importantes y 19 poco importantes. Para ambos patógenos, los factores de riesgo importantes estuvieron relacionados con el uso previo de antibióticos y la hospitalización.

Conclusión

Se han identificado los principales factores de riesgo asociados a PARC y ABRC mediante una revisión de la evidencia disponible. Sin embargo, son necesarios estudios adicionales prospectivos que permitan identificar los pacientes con infecciones por dichos patógenos.

ABSTRACT

Objective

The aim of the study is to identify risk factors associated to infections caused by carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbapenem-resistant Acinetobacter baumannii (CRAB) in adult patients through a systematic literature review, classify them according to their importance and provide recommendations by experts in the Spanish context.

Material and methods

We developed a systematic literature review to identify risk factors associated to CRPA or CRAB infections and they were evaluated and discussed by a multidisciplinary panel of experts.

Results

There were included 29 studies for P. aeruginosa and 23 for A. baumannii out of 593 identified through systematic literature review. We identified 38 risk factors for P. aeruginosa and 36 for A. baumannii. After risk factor evaluation by the panel of experts, results for CRPA were: 11 important, 10 slightly important and 15 unimportant risk factors; and for CRAB were: 9 important, 5 slightly important and 19 unimportant risk factors. For both pathogens, previous use of antibiotics and hospitalization were important risk factors.

Conclusion

We could identify the main risk factors associated to CRPA and CRAB through literature review. There is a need for developing additional studies with higher levels of evidence to identify sooner and better infected patients through associated risk factors.

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Most cited references 22

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Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

Alessandro Cassini, Liselotte Diaz Högberg, Diamantis Plachouras … (2019)

Summary Background Infections due to antibiotic-resistant bacteria are threatening modern health care. However, estimating their incidence, complications, and attributable mortality is challenging. We aimed to estimate the burden of infections caused by antibiotic-resistant bacteria of public health concern in countries of the EU and European Economic Area (EEA) in 2015, measured in number of cases, attributable deaths, and disability-adjusted life-years (DALYs). Methods We estimated the incidence of infections with 16 antibiotic resistance–bacterium combinations from European Antimicrobial Resistance Surveillance Network (EARS-Net) 2015 data that was country-corrected for population coverage. We multiplied the number of bloodstream infections (BSIs) by a conversion factor derived from the European Centre for Disease Prevention and Control point prevalence survey of health-care-associated infections in European acute care hospitals in 2011–12 to estimate the number of non-BSIs. We developed disease outcome models for five types of infection on the basis of systematic reviews of the literature. Findings From EARS-Net data collected between Jan 1, 2015, and Dec 31, 2015, we estimated 671 689 (95% uncertainty interval [UI] 583 148–763 966) infections with antibiotic-resistant bacteria, of which 63·5% (426 277 of 671 689) were associated with health care. These infections accounted for an estimated 33 110 (28 480–38 430) attributable deaths and 874 541 (768 837–989 068) DALYs. The burden for the EU and EEA was highest in infants (aged <1 year) and people aged 65 years or older, had increased since 2007, and was highest in Italy and Greece. Interpretation Our results present the health burden of five types of infection with antibiotic-resistant bacteria expressed, for the first time, in DALYs. The estimated burden of infections with antibiotic-resistant bacteria in the EU and EEA is substantial compared with that of other infectious diseases, and has increased since 2007. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases. Funding European Centre for Disease Prevention and Control.

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Risk factors for hospitalized patients with resistant or multidrug-resistant Pseudomonas aeruginosa infections: a systematic review and meta-analysis

Gowri Raman, Esther E Avendano, Jeffrey Chan … (2018)

Background Identifying risk factors predicting acquisition of resistant Pseudomonas aeruginosa will aid surveillance and diagnostic initiatives and can be crucial in early and appropriate antibiotic therapy. We conducted a systematic review examining risk factors of acquisition of resistant P. aeruginosa among hospitalized patients. Methods MEDLINE®, EMBASE®, and Cochrane Central were searched between 2000 and 2016 for studies examining independent risk factors associated with acquisition of resistant P. aeruginosa, among hospitalized patients. Random effects model meta-analysis was conducted when at least three or more studies were sufficiently similar. Results Of the 54 eligible articles, 28 publications (31studies) examined multi-drug resistant (MDR) or extensively drug resistant (XDR) P. aeruginosa and 26 publications (29 studies) examined resistant P. aeruginosa. The acquisition of MDR P. aeruginosa, as compared with non-MDR P. aeruginosa, was significantly associated with intensive care unit (ICU) admission (3 studies: summary adjusted odds ratio [OR] 2.2) or use of quinolones (4 studies: summary adjusted OR 3.59). Acquisition of MDR or XDR compared with susceptible P. aeruginosa was significantly associated with prior hospital stay (4 studies: summary adjusted OR 1.90), use of quinolones (3 studies: summary adjusted OR 4.34), or use of carbapenems (3 studies: summary adjusted OR 13.68). The acquisition of MDR P. aeruginosa compared with non-P. aeruginosa was significantly associated with prior use of cephalosporins (3 studies: summary adjusted OR 3.96), quinolones (4 studies: summary adjusted OR 2.96), carbapenems (6 studies: summary adjusted OR 2.61), and prior hospital stay (4 studies: summary adjusted OR 1.74). The acquisition of carbapenem-resistant P. aeruginosa compared with susceptible P. aeruginosa, was statistically significantly associated with prior use of piperacillin-tazobactam (3 studies: summary adjusted OR 2.64), vancomycin (3 studies: summary adjusted OR 1.76), and carbapenems (7 studies: summary adjusted OR 4.36). Conclusions Prior use of antibiotics and prior hospital or ICU stay was the most significant risk factors for acquisition of resistant P. aeruginosa. These findings provide guidance in identifying patients that may be at an elevated risk for a resistant infection and emphasize the importance of antimicrobial stewardship and infection control in hospitals. Electronic supplementary material The online version of this article (10.1186/s13756-018-0370-9) contains supplementary material, which is available to authorized users.

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Carbapenem-resistant Acinetobacter baumannii in intensive care unit patients: risk factors for acquisition, infection and their consequences.

E Playford, J C Craig, J Iredell (2007)

A retrospective case-control study was performed to assess risk factors and the clinical and economic consequences associated with acquisition of carbapenem-resistant Acinetobacter baumannii (CR-AB) in an intensive care unit (ICU) over a 24-month period. CR-AB was acquired by 64 of 1431 ICU admissions; each was matched with two controls. Risk factors associated with CR-AB acquisition included ICU-wide variables, such as 'colonization pressure' (the prevalence of ICU colonized patients) and ICU antibiotic use over the preceding three months, as well as patient-related variables. Among colonized patients, risk factors for CR-AB infection included transfusion and 'colonization density' (the proportion of body sites colonized with CR-AB). CR-AB infection was independently associated with increased hospital mortality [mortality difference: 20%; 95% confidence interval (CI): 1-40%], prolonged ICU stay (median length of stay difference: 15 days; 95% CI: 9-21 days) and prolonged hospital stay (30 days, 11-38 days) compared with matched controls.

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Author and article information

Journal

Journal ID (nlm-ta): Rev Esp Quimioter

Journal ID (iso-abbrev): Rev Esp Quimioter

Journal ID (publisher-id): Sociedad Española de Quimioterapia

Title: Revista Española de Quimioterapia

Publisher: Sociedad Española de Quimioterapia

ISSN (Print): 0214-3429

ISSN (Electronic): 1988-9518

Publication date (Electronic): 29 April 2021

Publication date (Print): 2021

Volume: 34

Issue: 4

Pages: 298-307

Affiliations

[1 ]Servicio de Medicina Intensiva Hospital Universitario Vall d´Hebrón, Barcelona, España

[2 ]Servicio de Enfermedades Infecciosas Hospital Clínic de Barcelona, IDIBAPS, Universidad de Barcelona, España

[3 ]Servicio de Microbiología Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España

[4 ]Servicio de Enfermedades Infecciosas y Microbiología Clínica Universidad de Navarra, España

[5 ]Servicio de Enfermedades Infecciosas Hospital Clínic de Barcelona, España

[6 ]Unidad Clínica Cuidados Intensivos Hospital Universitario Virgen de la Macarena, Sevilla, España

[7 ]Servicio de Microbiología Hospital Universitario Vall d´Hebrón, Vall d’Hebron Institut de Recerca, Universitat Autònoma de Barcelona, España

[8 ]Servicio de Medicina Intensiva Complejo Hospitalario Universitario De Santiago de Compostela, España

[9 ]Servicio de Enfermedades Infecciosas Hospital Universitario y Politécnico La Fe, Valencia, España

[10 ]Servicio Enfermedades Infecciosas Hospital Universitario Ramón y Cajal, e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España

[11 ]Omakase Consulting, Barcelona, España

Author notes

Correspondencia: Xavier Badia Omakase Consulting, Barcelona, España E-mail: xbadia@ 123456omakaseconsulting.com

Article

Publisher ID: revespquimioter-34-298

DOI: 10.37201/req/034.2021

PMC ID: 8329577

PubMed ID: 33913312

SO-VID: 9f639376-7895-4af0-a9d3-51883aa7584e

License:

Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)( https://creativecommons.org/licenses/by-nc/4.0/).

History

Date received : 18 February 2021

Date revision received : 02 March 2021

Date revision received : 08 March 2021

Date accepted : 14 March 2021

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RESUMEN

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Material y métodos

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Estadística bayesiana

Most cited references 22

Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

Risk factors for hospitalized patients with resistant or multidrug-resistant Pseudomonas aeruginosa infections: a systematic review and meta-analysis

Carbapenem-resistant Acinetobacter baumannii in intensive care unit patients: risk factors for acquisition, infection and their consequences.

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