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Respiratory Investigation Mar 2024Carbapenem is recommended as one of the first-line regimens for ventilator-associated pneumonia (VAP), but no recent systematic review has fully investigated its... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Carbapenem is recommended as one of the first-line regimens for ventilator-associated pneumonia (VAP), but no recent systematic review has fully investigated its efficacy. This systematic review aims to evaluate the efficacy of carbapenem compared with non-carbapenem for VAP treatment.
METHODS
We performed a systematic review and meta-analysis of studies comparing the efficacy and the safety between carbapenem and non-carbapenem with activity to Pseudomonas aeruginosa in the treatment for VAP. The main outcome was mortality, and the additional outcomes were the clinical cure of pneumonia, length of intensive care unit stay, recurrence, adverse effects, and the development of resistant bacteria. This study was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
Of the initial 1,730 publications, 9 randomized control trials were enrolled. In the meta-analysis, no difference was observed between the carbapenem and non-carbapenem regimens in improving mortality (odds ratio, 0.83; 95 % confidence interval (CI) 0.67-1.02). While the carbapenem regimen was superior to the non-carbapenem regimen in studies reporting the resolution of pneumonia (odds ratio, 1.09; 95 % CI 1.01-1.17), the effectiveness of carbapenem treatment was not evident in studies assessing the other outcomes.
CONCLUSIONS
Carbapenem might have no superiority in survival when treating VAP. Moreover, non-carbapenem antibiotics with activities to P. aeruginosa have a potential option to avoid inducing carbapenem-resistant pathogens.
Topics: Humans; Pneumonia, Ventilator-Associated; Carbapenems; Anti-Bacterial Agents
PubMed: 38190794
DOI: 10.1016/j.resinv.2023.12.006 -
Heliyon Oct 2023Carbapenems and β-lactam and β-lactamase inhibitors (BLBLIs) have been used empirically in nosocomial pneumonia, but their efficacy and safety are controversial.
BACKGROUND
Carbapenems and β-lactam and β-lactamase inhibitors (BLBLIs) have been used empirically in nosocomial pneumonia, but their efficacy and safety are controversial.
OBJECTIVE
We carried out a systematic review with meta-analysis to evaluate the efficacy and safety of carbapenems versus BLBLIs against nosocomial pneumonia.
METHODS
PubMed, Embase, Cochrane Central Register of Controlled Trials, CNKI, Wangfang, VIP and Sinomed were searched systematically through April 29, 2023 for clinical trials comparing carbapenems with BLBLIs for treatment of nosocomial pneumonia. Random-effects models were used to evaluate the impact of treatment on the risk ratio (RR) of all-cause mortality, clinical response, microbiologic response, resistance by , adverse effects (AEs), and serious adverse effects. The quality of the evidence was assessed with the Cochrane risk of bias tool. The review was registerted in the INPLASY (INPLASY202340113).
RESULTS
Seven randomized controlled trials containing 3306 patients met our inclusion criteria Our meta-analysis showed no significant difference in all-cause mortality (RR = 0.88, 95% confidence interval [CI] = 0.75-1.03, I = 0%) or clinical cure (1.02, 0.96-1.09, 30%) or clinical failure (1.19, 0.97-1.47, 0%) or microbiologic clinical cure (0.98, 0.89-1.06, 40%) or resistance (RR 2.43, CI 0.86-6.81, 49%, P = 0.09) or adverse events (0.98, 0.93-1.02, 0%) between carbapenems groups BLBLIs groups, but a significant difference was found for severe adverse events (RR 0.83, CI 0.73-0.94, 0%).
CONCLUSION
Differences in the prevalence of mortality, clinical cure, or clinical failure were not observed between carbapenems groups BLBLIs groups in terms of nosocomial pneumonia. The use of carbapenems was linked to a tendency towards the emergence of resistance, however, no statistically significant difference was observed.
PubMed: 37767465
DOI: 10.1016/j.heliyon.2023.e20108 -
The Journal of Hospital Infection Jun 2024The optimal duration of therapy for Pseudomonas aeruginosa bloodstream infection (PSA-BSI) is unknown, with prolonged therapy frequently favored due to severity of... (Meta-Analysis)
Meta-Analysis Comparative Study
The optimal duration of therapy for Pseudomonas aeruginosa bloodstream infection (PSA-BSI) is unknown, with prolonged therapy frequently favored due to severity of infection, patient complexity, risk of multi-drug resistance, and high mortality. We therefore conducted a systematic review and meta-analysis of studies with head-to-head comparison of short versus prolonged therapy for PSA-BSI. A comprehensive search including Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus was performed. We pooled risk ratios using DerSimonian-Laird random effects model and performed subgroup analysis of outcomes including all-cause mortality, recurrent infection, and composite of these outcomes among patients receiving short versus prolonged therapy for PSA-BSI. Heterogeneity was assessed by the I-index. Risk of bias for cohort studies was assessed using ROBINS-I tool. Of the 908 identified studies, six were included in the systematic review and five studies with head-to-head comparison of treatment duration were assessed in the meta-analysis, totalling 1746 patients. No significant difference in propensity score-weighted composite outcome (30-day all-cause mortality or recurrent infection) was noted between patients receiving short or prolonged therapy, with a pooled RR risk ratio of 0.80 (95% CI confidence interval 0.51-1.25, P=0.32; I = 0%). Additionally, duration of therapy did not impact individual outcomes of 30-day all-cause mortality or recurrent/persistent infection. Our meta-analysis demonstrated that short duration of antimicrobial therapy may have similar efficacy to prolonged treatment for PSA-BSI. Future randomized trials will be necessary to definitively determine optimal management of PSA bacteraemia.
Topics: Humans; Pseudomonas Infections; Bacteremia; Pseudomonas aeruginosa; Anti-Bacterial Agents; Treatment Outcome; Duration of Therapy; Survival Analysis; Time Factors
PubMed: 38685414
DOI: 10.1016/j.jhin.2024.04.007 -
APMIS : Acta Pathologica,... Feb 2024The objectives of this study were to perform a systematic review of publications between 2010 and 2021 on the antibiotic resistance of Pseudomonas aeruginosa and...
The objectives of this study were to perform a systematic review of publications between 2010 and 2021 on the antibiotic resistance of Pseudomonas aeruginosa and Acinetobacter baumannii from urinary tract infections and to analyze changes over time in hospital urine cultures from 2016 through 2021. The literature was searched, and a retrospective cross-sectional descriptive study was performed in the hospital. Out of 21 838 positive urine cultures, 3.86% were due to P. aeruginosa and 0.44% were due to A. baumannii. For P. aeruginosa, lower resistance rates were observed to virtually all tested antibiotics than were obtained in the systematic review, and the present series of hospital samples showed an in vitro resistance rate <10% to ceftazidime, cefepime, meropenem, piperacillin-tazobactam, amikacin, tobramycin, and colistin. For A. baumannii, the resistance rates to almost all antibiotics were higher in the present series than in the systematic review, being lowest to colistin (10%). Both microorganisms show reduced in vitro susceptibility to some antibiotics during the years of the COVID-19 pandemic in comparison to previous years. In our setting, both piperacillin-tazobactam and meropenem can be recommended for the empirical treatment of UTIs by P. aeruginosa, whereas only colistin can be recommended for UTIs by A. baumannii.
Topics: Humans; Pseudomonas aeruginosa; Meropenem; Acinetobacter baumannii; Spain; Colistin; Cross-Sectional Studies; Retrospective Studies; Pandemics; Anti-Bacterial Agents; Pseudomonas Infections; Piperacillin, Tazobactam Drug Combination; Urinary Tract Infections; Drug Resistance, Multiple, Bacterial; Hospitals; Microbial Sensitivity Tests
PubMed: 37971152
DOI: 10.1111/apm.13360 -
Infection Jun 2024The landscape of Pseudomonas infective endocarditis (IE) is evolving with the widespread use of cardiac implantable devices and hospital-acquired infections. This... (Review)
Review
BACKGROUND
The landscape of Pseudomonas infective endocarditis (IE) is evolving with the widespread use of cardiac implantable devices and hospital-acquired infections. This systematic review aimed to evaluate the emerging risk factors and outcomes in Pseudomonas IE.
METHODS
A literature search was performed in major electronic databases (PubMed, Scopus, and Google Scholar) with appropriate keywords and combinations till November 2023. We recorded data for risk factors, diagnostic and treatment modalities. This study is registered with PROSPERO, CRD42023442807.
RESULTS
A total of 218 cases (131 articles) were included. Intravenous drug use (IDUs) and prosthetic valve endocarditis (PVE) were major risk factors for IE (37.6% and 22%). However, the prosthetic valve was the predominant risk factor in the last two decades (23.5%). Paravalvular complications (paravalvular leak, abscess, or pseudoaneurysm) were described in 40 cases (18%), and the vast majority belonged to the aortic valve (70%). The mean time from symptom onset to presentation was 14 days. The incidence of difficult-to-treat resistant (DTR) pseudomonas was 7.4%. Valve replacement was performed in 57.3% of cases. Combination antibiotics were used in most cases (77%), with the aminoglycosides-based combination being the most frequently used (66%). The overall mortality rate was 26.1%. The recurrence rate was 11.2%. Almost half of these patients were IDUs (47%), and most had aortic valve endocarditis (76%).
CONCLUSIONS
This review highlights the changing epidemiology of Pseudomonas endocarditis with the emergence of prosthetic valve infections. Acute presentation and associated high mortality are characteristic of Pseudomonas IE and require aggressive diagnostic and therapeutic approach.
PubMed: 38856808
DOI: 10.1007/s15010-024-02311-z -
Clinical Microbiology and Infection :... Mar 2024To prioritize healthcare investments, ranking of infections caused by antibiotic-resistant bacteria should be based on accurate incidence data. (Meta-Analysis)
Meta-Analysis Review
Frequency of bloodstream infections caused by six key antibiotic-resistant pathogens for prioritization of research and discovery of new therapies in Europe: a systematic review.
BACKGROUND
To prioritize healthcare investments, ranking of infections caused by antibiotic-resistant bacteria should be based on accurate incidence data.
OBJECTIVES
We performed a systematic review to estimate frequency measures of antimicrobial resistance for six key bacteria causing bloodstream infections (BSI) in European countries.
DATA SOURCES
We searched PubMed, Web of Science, Embase databases, and the ECRAID-Base Epidemiological-Network platform.
STUDY ELIGIBILITY CRITERIA
We included studies and surveillance systems assessing resistance-percentage, prevalence, or incidence-density of BSI because of carbapenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli, third-generation cephalosporins-resistant E. coli and K. pneumoniae, vancomycin-resistant Enterococcus faecium, and methicillin-resistant Staphylococcus aureus.
METHODS
Reviewers independently assessed published data and evaluated study quality with the modified Joanna Briggs Institute critical appraisal tool. Pooled estimates were determined using random effects meta-analysis. Consistency of data was assessed using random effects meta-regression (Wald test, p > 0.05).
RESULTS
We identified 271 studies and 52 surveillance systems from 32 European countries. Forty-five studies (16%) reported on BSI, including 180 frequency measures most commonly as resistance-percentage (88, 48.9%). Among 309 frequency measures extracted from 24 (46%) surveillance systems, 278 (89%) were resistance-percentages. Frequency measures of methicillin-resistant S. aureus and vancomycin-resistant E. faecium BSI were more frequently reported from Southern Europe and Western Europe (80%), whereas carbapenem-resistant P. aeruginosa BSI from Northern Europe and Western Europe (88%). Highest resistance-percentages were detected for carbapenem-resistant A. baumannii (66% in Central Eastern Europe) and carbapenem-resistant K. pneumoniae (62.8% in Southern Europe). Pooled estimates showed lower resistance-percentages in community versus healthcare-associated infections and in children versus adults. Estimates from studies and surveillance systems were mostly consistent among European regions. The included data was of medium quality.
DISCUSSION
Pathogen-specific frequency measures of antimicrobial resistance in BSI are insufficient to inform antibiotic stewardship and research and development strategies. Improving data collection and standardization of frequency measures is urgently needed.
Topics: Child; Adult; Humans; Anti-Bacterial Agents; Methicillin-Resistant Staphylococcus aureus; Vancomycin; Escherichia coli; Bacteremia; Drug Resistance, Bacterial; Bacteria; Carbapenems; Sepsis; Europe; Klebsiella pneumoniae; Microbial Sensitivity Tests
PubMed: 38007387
DOI: 10.1016/j.cmi.2023.10.019 -
Open Forum Infectious Diseases Feb 2024is one of the most common pathogens in surgical site infections (SSIs). However, comprehensive epidemiological and antibiotic resistance details for in Chinese SSIs...
BACKGROUND
is one of the most common pathogens in surgical site infections (SSIs). However, comprehensive epidemiological and antibiotic resistance details for in Chinese SSIs are lacking. We evaluated the proportions and antimicrobial resistance of among patients with SSIs in China.
METHODS
Relevant papers from January 2010 to August 2022 were searched in databases including PubMed, Embase, Web of Science, China Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang, and Weipu. A meta-analysis was performed to analyze the proportions and 95% confidence interval (CIs) of among patients with SSIs. Meta-regression analysis was used to investigate the proportion difference among different subgroups and antimicrobial resistance.
RESULTS
A total of 72 studies met inclusion criteria, involving 33 050 isolated strains. The overall proportion of among patients with SSIs was 16.0% (95% CI, 13.9%-18.2%). Subgroup analysis showed higher proportions in orthopedic (18.3% [95% CI, 15.6%-21.0%]) and abdominal surgery (17.3% [95% CI, 9.9%-26.2%]). The proportion in the central region (18.6% [95% CI, 15.3%-22.1%]) was slightly higher than that in other regions. Antibiotic resistance rates significantly increased after 2015: cefoperazone (36.2%), ceftriaxone (38.9%), levofloxacin (20.5%), and aztreonam (24.0%). Notably, resistance to ampicillin and cefazolin exceeded 90.0%.
CONCLUSIONS
The proportion of infection among patients with SSIs was higher than the data reported by the Chinese Antimicrobial Resistance Surveillance System, indicating rising antimicrobial resistance. The existing antimicrobial drug management plan should be strengthened to prevent a hospital epidemic of drug-resistant strains.
PubMed: 38328500
DOI: 10.1093/ofid/ofad647 -
Infection and Drug Resistance 2024The World Health Organization (WHO) has classified carbapenem-resistant (), and () as high-priority pathogens, and carbapenem-resistant bacteria (CRB) have been... (Review)
Review
BACKGROUND
The World Health Organization (WHO) has classified carbapenem-resistant (), and () as high-priority pathogens, and carbapenem-resistant bacteria (CRB) have been reported to spread between humans, animals, and the environment.
OBJECTIVE
This study aimed to conduct a systematic review of carbapenem resistance in animals, foods, and the environment on the African continent and to provide recommendations and perspectives for better prevention and control of carbapenem resistance in Africa.
RESULTS
A total of 137 research articles collected from 2009 to 2023 were selected for this review, including articles reporting carbapenem-resistant bacteria in animals (81/137; 59.1%), the environment (66/137; 48.2%), and foods (26/137; 19%). Carbapenem-resistant bacterial species belonged to 31 genera and 17 families, including mainly spp. (68/127; 53.5%); spp. (45/127; 35.4%); spp. (20/127; 15.7%), spp. (19/127; 15%) and spp. (15/127; 11.8%). The prevalence of CRBs by country ranged from 1.1% to 48.5%, and the pooled prevalence of CRBs isolated from animal-environment-food in Africa was 19.1% (2804/14,684; Standard Deviation = 15). Twenty carbapenemase families belonging to A, B, C, and D Ambler classes were reported, including mainly carbapenemase genes from (44/84; 52.4%), (34/84; 40.5%), (23/84; 27.4%), (22/84; 26.2%), (19/84; 22.6%), and (12/84; 14.3%) families. The reported mobile genetic elements (MGE) carrying carbapenemase-encoding genes included plasmids (16/19; 84.2%), integrons (3/19; 15.8%), transposons (3/19; 15.8%), and insertion sequences (2/19; 10.5%). was often carried by (60kb-65kb) IncL/M-type pOXA-48 plasmids, while was often carried by (45-50kb) IncX-type plasmids. Moreover, 25 articles investigated and reported virulent and hypervirulent CRBs that carried multiple virulence factors.
CONCLUSION
Animal-environment-food ecosystems would constitute reservoirs of CRBs involved in human infections. The One Health approach and constant collaboration between governments are necessary to drastically reduce the mortality rates linked to antimicrobial resistance.
PubMed: 38715963
DOI: 10.2147/IDR.S458317 -
Ocular Immunology and Inflammation May 2024To provide a comprehensive overview of predisposing factors and clinical-microbiological profile of neonatal corneal ulcer.
OBJECTIVE
To provide a comprehensive overview of predisposing factors and clinical-microbiological profile of neonatal corneal ulcer.
METHODS
The literature search was undertaken in PubMed, SCOPUS, Embase, Web of Science, and Google Scholar databases on published papers from inception to May 31, 2023. The included articles were independently assessed for methodological quality using a Joanna Briggs Institute checklist. Weighted analysis was utilized, assigning a weight of one to each case report and a weight equivalent to the sample size for the case series/original studies.
RESULT
We included 34 relevant case reports/series and one original study. Seventy-four neonates were enrolled with a boy-to-girl ratio of 1.3:1 and a median age of 17 days (1-27 days). Prematurity and neonatal intensive care unit (NICU) care (21.6%), congenital horizontal tarsal kink (13.5%), neonatal herpes infection (13.5%), congenital entropion (5.4%), and jaundice (5.4%) were the most common potential risk factors and coexisting conditions. Microbiology evaluation showed positive results in 53.8% (21/39 cases). Viral and bacterial infections were the most common cause, followed by fungal infections. Herpes virus (18.9%), Pseudomonas aeruginosa (18.9%%) and Staphylococcus epidermidis (6.7%) were the most prevalent causative agents. Negative microbiology was significantly more common in neonates with structural abnormalities (14.9%) compared to others (6.8%) ( = 0.01).
CONCLUSION
Based on the findings of reported studies, this systematic review has increased awareness of the risk factors and etiologies that lead to developing corneal ulcers in neonates.
PubMed: 38709200
DOI: 10.1080/09273948.2024.2346246 -
Microbiology (Reading, England) Jul 2023, a combination of honey and vinegar, has been used as a remedy for wounds and infections in historical and traditional medical settings. While honey is now clinically...
, a combination of honey and vinegar, has been used as a remedy for wounds and infections in historical and traditional medical settings. While honey is now clinically used to treat infected wounds, this use of a complex, raw natural product (NP) mixture is unusual in modern western medicine. Research into the antimicrobial activity of NPs more usually focuses on finding a single active compound. The acetic acid in vinegar is known to have antibacterial activity at low concentrations and is in clinical use to treat burn wound infections. Here, we investigated the potential for synergistic activity of different compounds present in a complex ingredient used in historical medicine (vinegar) and in an ingredient mixture (). We conducted a systematic review to investigate published evidence for antimicrobial effects of vinegars against human pathogenic bacteria and fungi. No published studies have explicitly compared the activity of vinegar with that of a comparable concentration of acetic acid. We then characterized selected vinegars by HPLC and assessed the antibacterial and antibiofilm activity of the vinegars and acetic acid, alone and in combination with medical-grade honeys, against and . We found that some vinegars have antibacterial activity that exceeds that predicted by their acetic acid content alone, but that this depends on the bacterial species being investigated and the growth conditions (media type, planktonic vs. biofilm). Pomegranate vinegars may be particularly interesting candidates for further study. We also conclude that there is potential for acetic acid, and some vinegars, to show synergistic antibiofilm activity with manuka honey.
Topics: Humans; Acetic Acid; Honey; Anti-Bacterial Agents; Biofilms; Biological Products
PubMed: 37435775
DOI: 10.1099/mic.0.001351