Mortality in patients with multidrug-resistant Pseudomonas aeruginosa infections: a meta-analysis

Abstract

Pseudomonas aeruginosa is the leading cause of nosocomial infections with high mortality rates owing to the limited therapeutic options for multidrug-resistant Pseudomonas aeruginosa (MDRPA) and metallo-beta-lactamase (MBL)-producing strains. Herein, we present a meta-analysis exploring the association between MDRPA and São Paulo MBL-1 (SPM-1)-producing strains vs. mortality. Online databases were screened to identify studies published between 2006 and 2016. A total of 15 studies, comprising 3,201 cases of P. aeruginosa infection, were included. Our results demonstrated a higher mortality rate among patients infected with MDRPA (44.6%, 363/813) than those with non-MDRPA infection (24.8%, 593/2,388) [odds ratio (OR) 2.39, 95% confidence interval (CI) 1.70-3.36, p <0.00001]. The risk of mortality in patients with non-SPM-1 strains was four times higher than that observed in the patients of the SPM-1 group; however, no statistically significant difference was observed (p = 0.43). In conclusion, the results of our study demonstrated that patients infected with MDRPA had a significantly higher mortality rate than that of patients infected with non-MDRPA strains, especially patients with bloodstream infection (BSI), immunosuppression, and inadequate antimicrobial therapy. The absence of studies on the molecular aspects of blaSPM-1 and its association with mortality limited the analysis; therefore, our results should be interpreted with caution. Our findings also highlight the need for more studies on the molecular aspects of resistance and the peculiarities of different nosocomial settings.

High prevalence of atypical virulotype and genetically diverse background among Pseudomonas aeruginosa isolates from a referral hospital in the Brazilian Amazon

“…Our data demonstrate the predomination and wide spread of SPM-1 MDR/XDR strains in Brazilian hospitals and with the increasing transmission trend of ESBLs CTX-M and OXA variants genes worldwide, as previously reported [20,23,45,76,81,82]. Finally, our results highlight the impact of horizontally acquired resistance mechanisms, mainly ESBLs and class B MBL, in the increasing resistance rates and its commonly association to MDR/XDR P. aeruginosa strains [18,21,23,79].…”

“…These findings emphasize the growing global trend on antibiotic resistance been reported by several studies and rises concern, especially in Latin America countries, where carbapenems still remains as the main choice for the treatment of infections by MDR P . aeruginosa [ 21 , 22 , 23 , 79 , 80 ]. A reduced number of transmissible resistance markers were detected among tested isolates, with bla CTX-M1 (20.4%– 11/54) as the most frequent, followed by bla SPM-1 (5/54–9.2%), bla OXA-2 (3/54–5.5%) and bla OXA-10 (3/54–5.5%).…”

“…The increasing trend of resistance to anti-pseudomonal antibiotics, especially carbapenems, aminoglycosides and fluoroquinolones has contributed to the emergence of P. aeruginosa MDR/XDR strains, posing a challenge to infection treatment [20][21][22]. Among the several resistance mechanisms in P. aeruginosa, the role of transferable resistance determinants is overwhelming, particularly those encoding classes A and D extended-spectrum β-lactamases (ESBLs) and class B metallo-β-lactamases (MBLs) [23][24][25][26].…”

Is the superbug fungus really so scary? A systematic review and meta-analysis of global epidemiology and mortality of Candida auris

“…Moreover, the mortality of C. auris was also compared with other drug-resistant organisms, which spread in similar ways in healthcare centers. A meta-analysis showed that the mortality of patients infected with multidrug-resistant Pseudomonas aeruginosa was 44.6% [ 76 ]. Besides, the overall mortality of BSIs of vancomycin resistant Staphylococcus aureus and carbapenem-resistant Klebsiella pneumoniae were 26.8 and 54.3% respectively [ 77 , 78 ].…”

Prevalence of multi-drug resistant (MDR) and extensively drug-resistant (XDR) phenotypes of Pseudomonas aeruginosa and Acinetobacter baumannii isolated in clinical samples from Northeast of Iran

“…aeruginosa account for 13–19% of hospital acquired infections (HAIs) each year in the US. Mortality rates between 2007 and 2009 was estimated 46.1%) [ 12 , 13 ]. MDR— P. aeruginosa isolates in South America and Malaysia were estimated as 8.2% and 6.9%, as well [ 4 ].…”