Cargando…

Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies

Whether carbapenem resistance is associated with mortality in patients with Pseudomonas aeruginosa bacteremia is controversial. To address this issue, we conducted a systematic review and meta-analysis based on cohort studies. We searched PubMed and Embase databases to identify articles (up to April...

Descripción completa

Detalles Bibliográficos
Autores principales: Zhang, Yu, Chen, Xiao-Li, Huang, Ai-Wei, Liu, Su-Ling, Liu, Wei-Jiang, Zhang, Ni, Lu, Xu-Zai
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820673/
https://www.ncbi.nlm.nih.gov/pubmed/27004762
http://dx.doi.org/10.1038/emi.2016.22
_version_ 1782425448172486656
author Zhang, Yu
Chen, Xiao-Li
Huang, Ai-Wei
Liu, Su-Ling
Liu, Wei-Jiang
Zhang, Ni
Lu, Xu-Zai
author_facet Zhang, Yu
Chen, Xiao-Li
Huang, Ai-Wei
Liu, Su-Ling
Liu, Wei-Jiang
Zhang, Ni
Lu, Xu-Zai
author_sort Zhang, Yu
collection PubMed
description Whether carbapenem resistance is associated with mortality in patients with Pseudomonas aeruginosa bacteremia is controversial. To address this issue, we conducted a systematic review and meta-analysis based on cohort studies. We searched PubMed and Embase databases to identify articles (up to April 2015). The DerSimonian and Laird random-effect model was used to generate a summary estimate of effect. Associations were evaluated in subgroups based on different patient characteristics and study quality criteria. Seven studies with a total of 1613 patients were finally included, of which 1 study had a prospective design, and the other 6 were retrospective. Our meta-analysis showed patients with carbapenem-resistant P. aeruginosa bacteremia were at a higher risk of death compared with those with carbapenem-susceptible P. aeruginosa bloodstream infections (pooled odds ratio (OR) from three studies reporting adjusted ORs: 3.07, 95% confidence interval (CI), 1.60–5.89; pooled OR from 4 studies only reporting crude ORs: 1.46, 95% CI, 1.10–1.94). The results were robust across a number of stratified analyses and a sensitivity analysis. We also calculated that 8%–18.4% of deaths were attributable to carbapenem resistance in four studies assessing the outcome with 30-day mortality, and these were 3% and 14.6%, respectively, in two studies using 7-day mortality or mortality during bacteremia as an outcome of interest. Carbapenem resistance had a deleterious impact on the mortality of P. aeruginosa bacteremia; however, the results should be interpreted cautiously because only three studies reporting adjusted ORs were included. More large-scale, well-designed prospective cohorts, as well as mechanistic studies, are urgently needed in the future.
format Online
Article
Text
id pubmed-4820673
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Nature Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-48206732016-04-17 Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies Zhang, Yu Chen, Xiao-Li Huang, Ai-Wei Liu, Su-Ling Liu, Wei-Jiang Zhang, Ni Lu, Xu-Zai Emerg Microbes Infect Original Article Whether carbapenem resistance is associated with mortality in patients with Pseudomonas aeruginosa bacteremia is controversial. To address this issue, we conducted a systematic review and meta-analysis based on cohort studies. We searched PubMed and Embase databases to identify articles (up to April 2015). The DerSimonian and Laird random-effect model was used to generate a summary estimate of effect. Associations were evaluated in subgroups based on different patient characteristics and study quality criteria. Seven studies with a total of 1613 patients were finally included, of which 1 study had a prospective design, and the other 6 were retrospective. Our meta-analysis showed patients with carbapenem-resistant P. aeruginosa bacteremia were at a higher risk of death compared with those with carbapenem-susceptible P. aeruginosa bloodstream infections (pooled odds ratio (OR) from three studies reporting adjusted ORs: 3.07, 95% confidence interval (CI), 1.60–5.89; pooled OR from 4 studies only reporting crude ORs: 1.46, 95% CI, 1.10–1.94). The results were robust across a number of stratified analyses and a sensitivity analysis. We also calculated that 8%–18.4% of deaths were attributable to carbapenem resistance in four studies assessing the outcome with 30-day mortality, and these were 3% and 14.6%, respectively, in two studies using 7-day mortality or mortality during bacteremia as an outcome of interest. Carbapenem resistance had a deleterious impact on the mortality of P. aeruginosa bacteremia; however, the results should be interpreted cautiously because only three studies reporting adjusted ORs were included. More large-scale, well-designed prospective cohorts, as well as mechanistic studies, are urgently needed in the future. Nature Publishing Group 2016-03 2016-03-23 /pmc/articles/PMC4820673/ /pubmed/27004762 http://dx.doi.org/10.1038/emi.2016.22 Text en Copyright © 2016 Shanghai Shangyixun Cultural Communication Co., Ltd http://creativecommons.org/licenses/by/4.0/ This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/
spellingShingle Original Article
Zhang, Yu
Chen, Xiao-Li
Huang, Ai-Wei
Liu, Su-Ling
Liu, Wei-Jiang
Zhang, Ni
Lu, Xu-Zai
Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies
title Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies
title_full Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies
title_fullStr Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies
title_full_unstemmed Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies
title_short Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies
title_sort mortality attributable to carbapenem-resistant pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820673/
https://www.ncbi.nlm.nih.gov/pubmed/27004762
http://dx.doi.org/10.1038/emi.2016.22
work_keys_str_mv AT zhangyu mortalityattributabletocarbapenemresistantpseudomonasaeruginosabacteremiaametaanalysisofcohortstudies
AT chenxiaoli mortalityattributabletocarbapenemresistantpseudomonasaeruginosabacteremiaametaanalysisofcohortstudies
AT huangaiwei mortalityattributabletocarbapenemresistantpseudomonasaeruginosabacteremiaametaanalysisofcohortstudies
AT liusuling mortalityattributabletocarbapenemresistantpseudomonasaeruginosabacteremiaametaanalysisofcohortstudies
AT liuweijiang mortalityattributabletocarbapenemresistantpseudomonasaeruginosabacteremiaametaanalysisofcohortstudies
AT zhangni mortalityattributabletocarbapenemresistantpseudomonasaeruginosabacteremiaametaanalysisofcohortstudies
AT luxuzai mortalityattributabletocarbapenemresistantpseudomonasaeruginosabacteremiaametaanalysisofcohortstudies