Pseudomonas infections among hospitalized adults in Latin America: a systematic review and meta-analysis

Abstract

Background: Treatment of resistant Pseudomonas aeruginosa infection continues to be a challenge in Latin American countries (LATAM). We synthesize the literature on the use of appropriate initial antibiotic therapy (AIAT) and inappropriate initial antibiotic therapy (IIAT) in P. aeruginosa infections, and the literature on risk factors for acquisition of resistant P. aeruginosa among hospitalized adult patients in LATAM.Methods: MEDLINE, EMBASE, Cochrane, and LILAC were searched between 2000 and August 2019. Abstracts and full-text articles were screened in duplicate. Random effects meta-analysis was conducted when studies were sufficiently similar.Results: The screening of 165 citations identified through literature search yielded 98 full-text articles that were retrieved and assessed for eligibility, and 19 articles conducted in Brazil (14 articles), Colombia (4 articles), and Cuba (1 article) met the inclusion criteria. Of 19 eligible articles, six articles (840 subjects) examined AIAT compared to IIAT in P. aeruginosa infections; 17 articles (3203 total subjects) examined risk factors for acquisition of resistant P. aeruginosa; and four articles evaluated both. Four of 19 articles were rated low risk of bias and the remaining were deemed unclear or high risk of bias. In meta-analysis, AIAT was associated with lower mortality for P. aeruginosa infections (unadjusted summary OR 0.48, 95% CI 0.28-0.81; I 2 = 59%), compared to IIAT and the association with mortality persisted in subgroup meta-analysis by low risk of bias (3 articles; unadjusted summary OR 0.46, 95% CI 0.28-0.81; I 2 = 0%). No meta-analysis was performed for studies evaluating risk factors for acquisition of resistant P. aeruginosa as they were not sufficiently similar. Significant risk factors for acquisition of resistant P. aeruginosa included: prior use of antibiotics (11 articles), stay in the intensive care unit (ICU) (3 articles), and comorbidity score (3 articles). Outcomes were graded to be of low strength of evidence owing to unclear or high risk of bias and imprecise estimates. Conclusion:Our study highlights the association of AIAT with lower mortality and prior use of antibiotics significantly predicts acquiring resistant P. aeruginosa infections. This review reinforces the need for rigorous and structured antimicrobial stewardship programs in the LATAM region.

Bacterial isolates from diabetic foot ulcers and their antimicrobial resistance profile from selected hospitals in Addis Ababa, Ethiopia

“…In the present study, S. aureus was the predominant isolate 25.19% (32/127), unlike a previous study in Ethiopia which reported, Klebsiella species 23.9% (22/92) as the predominant bacteria followed by Proteus species 18.47% (17/92) ( 15 ). In Egypt , P. mirabilis (16.8%) is the most common isolate ( 24 ), in Saudi Arabia Pseudomonas species 15.6% (n = 134) ( 27 ), and in South America Pseudomonas species (18.8%) was the most common isolate ( 28 ). Similarly in agreement with studies in Kenya 17.5% (14/80 ( 29 ), Nigeria 32.9% (32/97 ( 30 ), India 24.42% (32/131) ( 31 ), 25% (18/85) ( 21 ), China 65.2% (n=232) ( 25 ), and in Iran 28% (n=92) ( 32 ).…”

High mortality by nosocomial infections caused by carbapenem-resistant P. aeruginosa in a referral hospital in Brazil: facing the perfect storm

“…Studies have reported heightened resistance levels in P. aeruginosa, with an increasing prevalence, ranging between 15 and 60 % in certain countries [3][4][5]. Carbapenem resistance in P. aeruginosa isolates is an emerging problem, with nosocomial outbreaks of this micro-organism occurring worldwide, mainly in Brazil, contributing to increased morbidity and mortality rates, hospitalization time and treatment costs [6][7][8]. The resistance of P. aeruginosa to carbapenems has been reported as over 60 % in some Brazilian hospitals, and around 50 % in other developing countries, like Iran [9,10].…”

“…Carbapenem resistance in P. aeruginosa isolates is an emerging problem, with nosocomial outbreaks of this micro-organism occurring worldwide, mainly in Brazil, contributing to increased morbidity and mortality rates, hospitalization time and treatment costs [6–8]. The resistance of P.…”

Pseudomonal Diabetic Foot Infections: Vive la Différence?

“…Third, although the pressure offloading of the affected limb is a mainstay of the treatment of DFIs, 1 its efficiency greatly depends on the patient’s compliance, which we could not monitor in our assessments. Fourth, we compared only clinical parameters because we lacked the number of cases of pseudomonal DFIs with acquired antibiotic resistance 20 or virulence proteins, 24 required for adjustment in our multivariate analysis.…”

“…This fact usually leaves quinolone agents as the only oral antibiotics available for the treatment of pseudomonal DFIs. In addition to its natural resistance, P aeruginosa is also well known for its propensity to develop antibiotic resistance, 14 , 16 , 19 , 20 especially during therapy. 21 , 22 , 23 , 24 This observation motivates many experts to recommend a regimen comprising an initial combination antibiotic in most (or even all) severe pseudomonal infections, 9 , 22 especially for those with a substantial risk of recurrence.…”