Mortality due to KPC carbapenemase-producing Klebsiella pneumoniae infections: Systematic review and meta-analysis

Ramos-Castañeda, Jorge A.; Ruano-Raviña, Alberto; Barbosa-Lorenzo, Raquel; Paillier-Gonzalez, Jaime E.; Saldaña-Campos, Javier C.; Salinas, Diego; Lemos, Elkin

doi:10.1016/j.jinf.2018.02.007

Cited by 79 publications

(53 citation statements)

References 73 publications

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“…On the other hand, the overuse of antibiotic agents in patients without GNBSI usually leads to antibiotic resistance. GNBSI caused by antibiotic-resistant species has become a public health challenge with substantial morbidity and mortality [2,3]. Therefore, early diagnosis of GNBSI is crucial for disease management.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Procalcitonin Compared to C-Reactive Protein and Interleukin 6 in Recognizing Gram-Negative Bloodstream Infection: A Meta-Analytic Study

Lai

Wang

et al. 2020

Disease Markers

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Objective. Gram-negative bloodstream infections (GNBSIs), especially those caused by antibiotic-resistant species, have become a public health challenge. Procalcitonin (PCT) showed promising potential in early diagnosis of GNBSI; however, little was known about its performance under different clinical settings. We here systematically assessed the diagnostic accuracy of PCT in recognizing GNBSI and made direct comparisons with C-reactive protein (CRP) and interleukin 6 (IL-6). Methods. PubMed, Embase, ISI Web of Knowledge, and Scopus were searched from inception to March 15th, 2019. Area under the summary receiver operating characteristic curve (AUC), pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated. Hierarchical summary receiver operating characteristic (HSROC) model was used for the investigation of heterogeneity and for comparisons between markers. Results. 25 studies incorporating 50933 suspected BSI episodes were included. Pooled sensitivity and specificity for PCT were 0.71 and 0.76, respectively. The overall AUC was 0.80. The lowest AUCs were found in patients with febrile neutropenia (0.69) and hematological malignancy (0.69). The highest AUC was found in groups using electrochemiluminescence immunoassay (0.87). In direct comparisons, PCT showed better overall performance than CRP with the AUC being 0.85 (95% CI 0.81–0.87) for PCT and 0.78 (95% CI 0.74–0.81) for CRP, but the relative DORs varied with thresholds between PCT and CRP (p<0.001). No significant difference was found either in threshold (p=0.654) or in accuracy (p=0.480) between PCT and IL-6 in diagnosing GNBSI. Conclusions. PCT was helpful in recognizing GNBSI, but the test results should be interpreted carefully with knowledge of patients’ medical condition and should not serve as the only criterion for GNBSI. Further prospective studies are warranted for comparisons between different clinical settings.

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Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Procalcitonin Compared to C-Reactive Protein and Interleukin 6 in Recognizing Gram-Negative Bloodstream Infection: A Meta-Analytic Study

Lai

Wang

et al. 2020

Disease Markers

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“…Similarly, antimicrobial use (AMU) and resistance (AMR) represent a growing threat to global public health and the sustainability of healthcare services [8]. The spreading of carbapenemase-producing Enterobacteriaceae since 2010 is associated with high lethality in hospital settings [9] and a global alert has been raised by the World Health Organization (WHO) [10]. A systematic review of infections with antibiotic-resistant bacteria in the EU estimated about 670,000 cases in 2015, of which 63.5% were associated with healthcare.…”

Section: Introductionmentioning

confidence: 99%

A 2-year point-prevalence surveillance of healthcare-associated infections and antimicrobial use in Ferrara University Hospital, Italy

et al. 2020

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Background: Healthcare-Associated Infections (HAIs) represent one of the leading issues to patient safety as well as a significant economic burden. Similarly, Antimicrobial Use (AMU) and Resistance (AMR) represent a growing threat to global public health and the sustainability of healthcare services. Methods: A Point Prevalence Survey (PPS) following the 2016 ECDC protocol for HAI prevalence and AMU was conducted at Ferrara University Hospital (FUH). Data were collected by a team of trained independent surveyors in 2016 and 2018. Risk factors independently associated with HAI were assessed by a multivariate logistic regression model. Results: Of the 1102 patients surveyed, 115 (10.4%) had an active HAI and 487 (44.2%) were on at least 1 systemic antimicrobial agent. Factors independently associated with increased HAI risk were a "Rapidly Fatal" McCabe score (expected fatal outcome within 1 year), presence of medical devices (PVC, CVC, indwelling urinary catheter or mechanically assisted ventilation) and a length of hospital stay of at least 1 week. The most frequent types of HAI were pneumonia, bloodstream infections, and urinary tract infections. Antimicrobial resistance to third-generation cephalosporins was observed in about 60% of Enterobacteriaceae. Conclusions: The survey reports a high prevalence of HAI and AMU in FUH. Repeated PPSs are useful to control HAIs and AMU in large acute-care hospitals, highlighting the main problematic factors and allowing planning for improvement actions.

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“…Asimismo, se determinó que la IHQ de tipo órgano espacio es un factor asociado a la letalidad, similar a lo encontrado por Horasan et al 18 . La letalidad en este tipo de infecciones sobreviene por la ubicación en sitios anatómicos complejos y con irrigación comprometida, que hacen dispendiosa la penetración del antibiótico, máxime cuando un gran número de estas infecciones son producidas por gérmenes multirresistentes que presentan una elevada letalidad 37,38 , principalmente debido a la utilización de medicamentos que producen efectos adversos serios 39 .…”

Section: Discussionunclassified

Factores asociados a letalidad en pacientes con infección de herida quirúrgica. Estudio de casos y controles

Andrade-Mendez¹,

Ramos-Castañeda²,

M³

et al. 2020

Duazary

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Existe evidencia sobre los factores de riesgos asociados a la infección de la herida quirúrgica (IHQ), pero se desconocen estudios que hayan evaluado los factores asociados a la letalidad por la IHQ. Se propone un estudio para determinar los factores asociados a la letalidad en pacientes que desarrollaron una IHQ. Se realizó un estudio de casos y controles anidado a una cohorte de pacientes adultos diagnosticados con IHQ durante el periodo 2015 – 2016, en un hospital universitario de la región sur de Colombia. Los casos fueron pacientes con IHQ que presentaron letalidad dentro de los 30 días posteriores al inicio de la infección y los controles aquellos con IHQ que no fallecieron durante los 30 días. 150 pacientes cumplieron los criterios de selección. Los casos (fallecidos) correspondieron al 19,3%, quedando el grupo de los controles (vivos) con un 80,7%. Se encontró que controlando la edad y los días de hospitalización previos al procedimiento quirúrgico, la IHQ tipo órgano espacio es un factor asociado con letalidad en pacientes infectados (OR=2,5 IC95% 1,1 – 6,1). La letalidad en pacientes con IHQ fue elevada y representa un problema de salud pública por las consecuencias que ocasiona al paciente.

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Mortality due to KPC carbapenemase-producing Klebsiella pneumoniae infections: Systematic review and meta-analysis

Cited by 79 publications

References 73 publications

Diagnostic Accuracy of Procalcitonin Compared to C-Reactive Protein and Interleukin 6 in Recognizing Gram-Negative Bloodstream Infection: A Meta-Analytic Study

Diagnostic Accuracy of Procalcitonin Compared to C-Reactive Protein and Interleukin 6 in Recognizing Gram-Negative Bloodstream Infection: A Meta-Analytic Study

A 2-year point-prevalence surveillance of healthcare-associated infections and antimicrobial use in Ferrara University Hospital, Italy

Factores asociados a letalidad en pacientes con infección de herida quirúrgica. Estudio de casos y controles

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