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

Raman, Gowri; Avendano, Esther E; Chan, Jeffrey; Merchant, Sanjay; Puzniak, Laura

doi:10.1186/s13756-018-0370-9

Cited by 185 publications

(156 citation statements)

References 65 publications

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“…This might be due to variation in sample size, clinical site of infection, age of patients, hospital setting, duration of hospitalization, patients exposure to high risk devices or surgical procedures, microbiological methods employed for screening of MDR resistant strains. The highest proportion of MDR non-fermentative gram negative bacilli NI infection among the lower age groups in the present study is consistent with earlier studies elsewhere in the world [29,33,34]. On the other hand, in the present study all NIs observed among patients with intravenous catheterization.…”

Section: Discussionsupporting

confidence: 93%

Multi-drug resistance of blood stream, urinary tract and surgical site nosocomial infections of Acinetobacter baumannii and Pseudomonas aeruginosa among patients hospitalized at Felegehiwot referral hospital, Northwest Ethiopia: a cross-sectional study

2020

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Background Multi-drug resistant (MDR) Acinetobacter baumannii and Pseudomonas aeruginosa are major causes of nosocomial infections globally. They are the current World Health Organization critical priority pathogens for resistance, Antimicrobial resistance (AMR) surveillance and discovery of new antibiotics. However, there is paucity of data on nosocomial infections (NIs) caused by such superbugs in Ethiopia. Therefore, this study determined the magnitude and profile of nosocomial MDR A. baumannii and P. aeruginosa infections among patients hospitalized at Felegehiwot referral hospital, Northwest Ethiopia. Methods A cross-sectional study was conducted at Felegehiwot referral hospital from April 1 to July 31, 2018. A total of 238 patients with blood stream, urinary tract and surgical site NIs were enrolled conveniently. Either blood, urine and wound swab specimens were collected and processed using standard bacteriological procedures. A. baumannii and P. aeruginosa isolates were identified using standard bacteriological techniques and confirmed by automated Vitek2 Compact. Antimicrobial susceptibility testing on isolates was performed using the disk diffusion technique. The results were interpreted as per the standard zone sizes of Clinical and Laboratory Standards Institute.Chi-square test was done to determine associations among variables. P value < 0.05 was considered statistical significant. Results The median age of participants was 29 years. Overall,20(8.4%) of patients had nosocomial MDR A. baumannii and P. aeruginosa infections. The proportion of nosocomial MDR blood stream, urinary tract and surgical site infections were 13(8.9%), 5(8.3%) and 2 (6.3%), respectively. Patients with NI had lower mean age (24.9 years) (P = 0.035). All isolates of NIs were from patients with intravenous catheterization. The frequency of NI was 9(3.8%) for MDR A. baumannii and 11(4.6%) for MDR P.aeruginosa. A. baumannii and P. aeruginosa isolates were 100% MDR. All isolates of A. baumannii and P. aeruginosa were 100% resistant to ampicillin and piperacillin.A. baumannii isolates were 33.3 and 44.5% resistance against meropenem and ciprofloxacin, respectively while P.aeruginosa isolates revealed 36.4 and 45.5% resistance against ciprofloxacin and meropenem, respectively. Conclusions Health care associated infections of MDR A.baumannii and P. aeruginosa are critical problems in the study area. Therefore, urgent focused interventions required to contain the spreading of MDR NIs. Treatment of NIs for patients on health care should be guided by antimicrobial susceptibility testing.

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Section: Discussionsupporting

confidence: 93%

Multi-drug resistance of blood stream, urinary tract and surgical site nosocomial infections of Acinetobacter baumannii and Pseudomonas aeruginosa among patients hospitalized at Felegehiwot referral hospital, Northwest Ethiopia: a cross-sectional study

2020

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“…age groups in the present study is consistent with earlier studies elsewhere in the world [29,33,34].…”

Section: The Highest Proportion Of Mdr Non-fermentative Gram Negativesupporting

confidence: 93%

Multi-drug resistance of blood stream, urinary tract and surgical site nosocomial infections of Acinetobacter baumannii and Pseudomonas aeruginosa among patients hospitalized at Felegehiwot Referral Hospital, Northwest Ethiopia: A cross-sectional study

Motbinor

Mulu

Bereded

2019

Preprint

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Background: Multi-drug resistant (MDR) Acinetobacter baumannii and Pseudomonas aeruginosa are major causes of nosocomial infections globally. They are the current World Health Organization critical priority pathogens for resistance, AMR surveillance and discovery of new antibiotics. However, there is paucity of data on nosocomial infections (NIs) caused by such superbugs in Ethiopia. Therefore, this study determined the magnitude and profile of nosocomial MDR Acinetobacter baumannii and Pseudomonas aeruginosa infections among patients hospitalized at Felegehiwot referral hospital, Northwest Ethiopia. Methods: A cross-sectional study was conducted at Felegehiwot referral hospital from April 1 to July 31, 2018. A total of 238 patients with blood stream, urinary tract and surgical site NIs were enrolled conveniently. Either blood, urine and wound swab specimens were collected and processed using standard bacteriological procedures.A.baumannii and P.aeruginosa isolates were identified using standard bacteriological techniques and confirmed by automated Vitek2 Compact. Antimicrobial susceptibility testing on isolates was performed using the disk diffusion technique.The results interpreted as per the standard zone sizes of Clinical and Laboratory Standards Institute. Chi-square test was done to determine associations among variables. P.value < 0.05 was considered statistical significant. Results:The median age of participants was 29 years. Overall, 20 (8.4%) of patients had nosocomial MDR A.baumannii and P.aeruginosa infections.The proportion of nosocomial MDR blood stream, urinary tract and surgical site infections were 13 (8.9%), 5 (8.3%) and 2 (6.3%), respectively. Patients with NI has lower mean age (24.9 years) (P=0.035). All isolates of NIs were from patients with intravenous catheterization. The frequency of NI was 9(3.8 %) for MDR A.baumannii and 11 (4.6%) for MDR P.aeruginosa. A.baumannii and P.aeruginosa isolates were 100% MDR.All isolates of A.baumannii and P.aeruginosa were 100% resistant to ampecillin and piperacillin. A.baumannii isolates were 33.3% and 44.5% resistance against meropenem and ciprofloxacin, respectively while P.aeruginosa isolates revealed 36.4% and 45.5% resistance against ciprofloxacin and meropenem, respectively. Conclusions: Health care associated MDR A.baumannii and P.aeruginosa infections are critical problems in the study area. Therefore, urgent focused interventions required to contain the spreading of MDR NIs. Treatment of NIs for patients on health care should be guided by antimicrobial susceptibility testing.

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“…Additionally, this review comprehensively searched for studies indexed in regional databases. The overall results from this review are consistent with other systematic reviews published literature from other regions that compare the role of AIAT with IIAT in mortality [8,35,36]. Nonetheless, in light of a few limitations, the results of the systematic review and metaanalysis should be interpreted with caution.…”

Section: Discussionsupporting

confidence: 85%

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

et al. 2020

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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.

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

Cited by 185 publications

References 65 publications

Multi-drug resistance of blood stream, urinary tract and surgical site nosocomial infections of Acinetobacter baumannii and Pseudomonas aeruginosa among patients hospitalized at Felegehiwot referral hospital, Northwest Ethiopia: a cross-sectional study

Multi-drug resistance of blood stream, urinary tract and surgical site nosocomial infections of Acinetobacter baumannii and Pseudomonas aeruginosa among patients hospitalized at Felegehiwot referral hospital, Northwest Ethiopia: a cross-sectional study

Multi-drug resistance of blood stream, urinary tract and surgical site nosocomial infections of Acinetobacter baumannii and Pseudomonas aeruginosa among patients hospitalized at Felegehiwot Referral Hospital, Northwest Ethiopia: A cross-sectional study

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

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