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African Journal of Laboratory Medicine 2018Healthcare-associated infection (HCAI) is a global health challenge, not only as an issue of patient safety but also as a major driver of antimicrobial resistance (AMR).... (Review)
Review
BACKGROUND
Healthcare-associated infection (HCAI) is a global health challenge, not only as an issue of patient safety but also as a major driver of antimicrobial resistance (AMR). It is a major cause of morbidity and mortality with economic consequences.
OBJECTIVE
This review provides an update on the occurrence of HCAI, as well as the contribution of emerging AMR on healthcare delivery in Africa.
METHODS
We searched PubMed, Cochrane database, African Journals Online and Google Scholar for relevant articles on HCAI in Africa between 2010 and 2017. Preferred reporting items of systematic reviews and meta-analyses guidelines were followed for selection. Thirty-five eligible articles were considered for the qualitative synthesis.
RESULTS
Of the 35 eligible articles, more than half ( = 21, 60%) were from East Africa. spp., and spp. were the common pathogens reported in bloodstream infection, (catheter-associated) urinary tract infection, surgical site infection and healthcare-associated pneumonia. Among these various subtypes of HCAI, methicillin-resistant (3.9% - 56.8%) and extended-spectrum beta-lactamase producing Gram-negative bacilli (1.9% - 53.0%) were the most reported antimicrobial resistant pathogens.
CONCLUSION
This review shows a paucity of HCAI surveillance in Africa and an emergence of AMR priority pathogens. Hence, there is a need for a coordinated national and regional surveillance of both HCAI and AMR in Africa.
PubMed: 30568902
DOI: 10.4102/ajlm.v7i2.796 -
Journal of Global Infectious Diseases 2018Multidrug-resistant (MDR ) is known as a serious threat to human health worldwide. Limited information is available concerning the prevalence of MDR in Iran. The aim...
BACKGROUND
Multidrug-resistant (MDR ) is known as a serious threat to human health worldwide. Limited information is available concerning the prevalence of MDR in Iran. The aim of the present study was to investigate the relative frequency of MDR in different parts of Iran.
MATERIALS AND METHODS
Using appropriate keywords and well-known English and Persian database, available data about MDR in Iran were retrieved. After applying predefined criteria, relevant studies were selected.
RESULTS
By using random-effect models, the pooled incidence of MDR was estimated 58% (95% confidence interval [CI]; 0.54-0.61). The highest and lowest prevalence of MDR were observed in Tehran (100%) (95% CI; 0.94-1.00) and Zahedan (16%) (95% CI; 0.10-0.24), respectively. The highest resistance rate was against ceftazidime (50%) (95% CI; 0.46-0.54) and amikacin (50%) (95% CI; 0.46-0.54).
CONCLUSION
Our findings are of concern since they demonstrate the high prevalence rate of MDR in the majority of Iranian hospitals.
PubMed: 30581263
DOI: 10.4103/jgid.jgid_113_17 -
Clinical Microbiology and Infection :... Mar 2024Quantifying the resource use and cost of antimicrobial resistance establishes the magnitude of the problem and drives action. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Quantifying the resource use and cost of antimicrobial resistance establishes the magnitude of the problem and drives action.
OBJECTIVES
Assessment of resource use and cost associated with infections with six key drug-resistant pathogens in Europe.
METHODS
A systematic review and Bayesian meta-analysis.
DATA SOURCES
MEDLINE (Ovid), Embase (Ovid), Econlit databases, and grey literature for the period 1 January 1990, to 21 June 2022.
STUDY ELIGIBILITY CRITERIA
Resource use and cost outcomes (including excess length of stay, overall costs, and other excess in or outpatient costs) were compared between patients with defined antibiotic-resistant infections caused by carbapenem-resistant (CR) Pseudomonas aeruginosa and Acinetobacter baumannii, CR or third-generation cephalosporin Escherichia coli (3GCREC) and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococcus faecium, and patients with drug-susceptible or no infection.
PARTICIPANTS
All patients diagnosed with drug-resistant bloodstream infections (BSIs).
INTERVENTIONS
NA.
ASSESSMENT OF RISK OF BIAS
An adapted version of the Joanna Briggs Institute assessment tool, incorporating case-control, cohort, and economic assessment frameworks.
METHODS OF DATA SYNTHESIS
Hierarchical Bayesian meta-analyses were used to assess pathogen-specific resource use estimates.
RESULTS
Of 5969 screened publications, 37 were included in the review. Data were sparse and heterogeneous. Most studies estimated the attributable burden by, comparing resistant and susceptible pathogens (32/37). Four studies analysed the excess cost of hospitalization attributable to 3GCREC BSIs, ranging from -€ 2465.50 to € 6402.81. Eight studies presented adjusted excess length of hospital stay estimates for methicillin-resistant S. aureus and 3GCREC BSIs (4 each) allowing for Bayesian hierarchical analysis, estimating means of 1.26 (95% credible interval [CrI], -0.72 to 4.17) and 1.78 (95% CrI, -0.02 to 3.38) days, respectively.
CONCLUSIONS
Evidence on most cost and resource use outcomes and across most pathogen-resistance combinations was severely lacking. Given the importance of this evidence for rational policymaking, further research is urgently needed.
Topics: Humans; Methicillin-Resistant Staphylococcus aureus; Bayes Theorem; Anti-Bacterial Agents; Anti-Infective Agents; Escherichia coli; Pseudomonas aeruginosa; Drug Resistance, Bacterial
PubMed: 38128781
DOI: 10.1016/j.cmi.2023.12.013 -
The Yale Journal of Biology and Medicine Dec 2022: Antibiotic resistance in cystic fibrosis (CF) is a well-known phenomenon. However, the comprehensive epidemiological impact of antibiotic resistance in CF is not... (Meta-Analysis)
Meta-Analysis Review
: Antibiotic resistance in cystic fibrosis (CF) is a well-known phenomenon. However, the comprehensive epidemiological impact of antibiotic resistance in CF is not clearly documented. So, this meta-analysis evaluated the proportion rates of carbapenem resistance (imipenem, meropenem, and doripenem) in CF based on publication date (1979-2000, 2001-2010, and 2011-2021), continents, pathogens, and antimicrobial susceptibility testing (AST). : We searched studies in PubMed, Scopus, and Web of Science (until April 2021). Statistical analyses were conducted using STATA software (version 14.0). : The 110 studies included in the analysis were performed in 25 countries and investigated 13,324 pathogens associated with CF. The overall proportion of imipenem, meropenem, and doripenem resistance in CF were 43% (95% CI 36-49), 48% (95% CI 40-57), 28% (95% CI 23-33), and 45% (95% CI 32-59), respectively. Our meta-analysis showed that trends of imipenem, meropenem, and doripenem-resistance had gradual decreases over time (1979-2021). This could be due to the limited clinical effectiveness of these antibiotics to treat CF cases over time. Among the opportunistic pathogens associated with CF, the highest carbapenem resistance rates were shown in , spp., , and . The highest and lowest carbapenem resistance rates among in CF patients were shown against meropenem (23%) and doripenem (39%). : We showed that trends of carbapenem resistance had decreased over time (1979-2021). This could be due to the limited clinical effectiveness of these antibiotics to treat CF cases over time. Plans should be directed to fight biofilm-associated infections and prevent the emergence of mutational resistance. Systematic surveillance for carbapenemase-producing pathogens in CF by molecular surveillance is necessitated.
Topics: Humans; Meropenem; Doripenem; Carbapenems; Cystic Fibrosis; Microbial Sensitivity Tests; Anti-Bacterial Agents; Imipenem; Pseudomonas aeruginosa
PubMed: 36568834
DOI: No ID Found -
The Cochrane Database of Systematic... Jan 2009Does newborn screening for cystic fibrosis (CF) improve clinical outcomes, quality of life and survival? (Review)
Review
BACKGROUND
Does newborn screening for cystic fibrosis (CF) improve clinical outcomes, quality of life and survival?
OBJECTIVES
To examine whether newborn screening for CF prevents or reduces irreversible organ damage and improves clinical outcomes, quality of life and survival in people with CF without unacceptable adverse effects.
SEARCH STRATEGY
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from electronic database searches, handsearches of relevant journals and abstract books of conference proceedings.The Group's Trials Register last searched: June 2008.
SELECTION CRITERIA
Randomised or quasi-randomised controlled trials, published and unpublished, comparing screening to clinical diagnosis in people with CF.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trial eligibility and quality and independently extracted data. Allocation concealment was unclear in both studies and sequence generation adequate in one.
MAIN RESULTS
Searches identified six trials. Two trials involving 1,124,483 neonates (210 with CF) with a maximum follow up of 17 years were eligible for inclusion. Varying study designs, outcomes reported and summary measures precluded calculation of pooled estimates and only data from one study were analysed. Severe malnutrition was less common among screened participants. Compared with screened participants, the odds ratio of weight below the tenth percentile was 4.12 (95% CI 1.64 to 10.38) and for height was 4.62 (95% CI 1.69 to 12.61) in the control group.At age seven, 88% of screened participants and 75% of controls had lung function parameters within normal limits of at least 89% predicted. At diagnosis chest radiograph scores were significantly better among screened participants; 33% of screened versus 50% of control participants had Wisconsin chest X-ray (WCXR) scores over five (P = 0.097) and 24% of screened versus 45% of control participants had Brasfield chest X-ray (BCXR) scores under 21 (P = 0.042)). Over time, chest radiograph scores were worse in the screened group (WCXR P = 0.017 and BCXR P = 0.041). Results were no longer significant after adjustment for genotype, pancreatic status, and Pseudomonas aeruginosa-culture results. In screened participants colonisation with Pseudomonas aeruginosa occurred earlier. Estimates suggest diagnosis through screening is less expensive.
AUTHORS' CONCLUSIONS
Two randomised controlled trials assessing neonatal screening in CF were identified; data from one study were included. Nutritional benefits are apparent. Screening provides potential for better pulmonary outcomes, but confounding factors influenced long-term pulmonary prognosis of people with CF. Screening seems less expensive than traditional diagnosis.
Topics: Cystic Fibrosis; Humans; Infant, Newborn; Neonatal Screening; Quality of Life; Randomized Controlled Trials as Topic; Survival Analysis
PubMed: 19160197
DOI: 10.1002/14651858.CD001402.pub2 -
European Journal of Microbiology &... Jan 2023This review aimed to evaluate the contamination rate of dental unit waterlines (DUWL) with Pseudomonas aeruginosa and Legionella pneumophila in several countries in the... (Review)
Review
This review aimed to evaluate the contamination rate of dental unit waterlines (DUWL) with Pseudomonas aeruginosa and Legionella pneumophila in several countries in the Middle East.Literature search was conducted in databases such as PubMed, Scopus, Web of Science, and Google Scholar to gather studies published from the beginning of 2000 to 30th April 2020. Medical Subject Headings (MeSH) terms were; "Legionellosis"; "Legionnaire", "Legionellosis", "L. pneumophila", "dent", "dental", "dentistry", "Dental Unit Waterlines", "dental water", "DUWL", "Middle East", "P. aeruginosa", "Iran", "Turkey", "Iraq", and "Jordan". The search was independently conducted by two of the authors. Data was analyzed using Comprehensive Meta-Analysis software.Almost all studies included in this review reported a high rate of bacterial contamination of DUWL, which exceeded the current standard bacterial contamination level of <200 (CFU) mL-1 recommended by the American Dental Association (ADA). The combined prevalence of L. pneumophila from four countries (Iran, Jordan, Turkey, and Iraq) was 23.5% (95% Cl: 6.5-57.7), and the combined prevalence of P. aeruginosa was reported 21.7% (95% Cl: 7.1-50.1%).This study showed a high bacterial contamination rate of DUWL with opportunistic pathogens. So, it is recommended to prevent biofilm formation in DUWL, some measures should be extended by practical approaches allowing for water quality control and improvement on-site in the dental practices such as mobile filtration units, chlorination and disinfection chemicals.
PubMed: 36626121
DOI: 10.1556/1886.2022.00023 -
The Cochrane Database of Systematic... Sep 2018Early diagnosis and treatment of lower respiratory tract infections are the mainstay of management of lung disease in cystic fibrosis. When sputum samples are... (Review)
Review
BACKGROUND
Early diagnosis and treatment of lower respiratory tract infections are the mainstay of management of lung disease in cystic fibrosis. When sputum samples are unavailable, treatment relies mainly on cultures from oropharyngeal specimens; however, there are concerns regarding the sensitivity of these to identify lower respiratory organisms.Bronchoscopy and related procedures (including bronchoalveolar lavage) though invasive, allow the collection of lower respiratory specimens from non-sputum producers. Cultures of bronchoscopic specimens provide a higher yield of organisms compared to those from oropharyngeal specimens. Regular use of bronchoscopy and related procedures may help in a more accurate diagnosis of lower respiratory tract infections and guide the selection of antimicrobials, which may lead to clinical benefits.This is an update of a previous review.
OBJECTIVES
To evaluate the use of bronchoscopy-guided antimicrobial therapy in the management of lung infection in adults and children with cystic fibrosis.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of latest search: 30 August 2018.We also searched three registries of ongoing studies and the reference lists of relevant articles and reviews. Date of latest search: 10 April 2018.
SELECTION CRITERIA
We included randomized controlled studies including people of any age with cystic fibrosis, comparing outcomes following therapies guided by the results of bronchoscopy (and related procedures) with outcomes following therapies guided by the results of any other type of sampling (including cultures from sputum, throat swab and cough swab).
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies, assessed their risk of bias and extracted data. We contacted study investigators for further information. The quality of the evidence was assessed using the GRADE criteria.
MAIN RESULTS
The search identified 11 studies, but we only included one study enrolling infants with cystic fibrosis under six months of age and diagnosed through newborn screening (170 enrolled); participants were followed until they were five years old (data from 157 children). The study compared outcomes following therapy directed by bronchoalveolar lavage for pulmonary exacerbations with standard treatment based on clinical features and oropharyngeal cultures.We considered this study to have a low risk of bias; however, the statistical power to detect a significant difference in the prevalence of Pseudomonas aeruginosa was limited due to the prevalence (of Pseudomonas aeruginosa isolation in bronchoalveolar lavage samples at five years age) being much lower in both the groups compared to that which was expected and which was used for the power calculation. The sample size was adequate to detect a difference in high-resolution computed tomography scoring. The quality of evidence for the key parameters was graded as low except high-resolution computed tomography scoring and cost of care analysis, which were graded as moderate quality.At five years of age, there was no clear benefit of bronchoalveolar lavage-directed therapy on lung function z scores or nutritional parameters. Evaluation of total and component high-resolution computed tomography scores showed no significant difference in evidence of structural lung disease in the two groups.In addition, this study did not show any difference between the number of isolates of Pseudomonas aeruginosa per child per year diagnosed in the bronchoalveolar lavage-directed therapy group compared to the standard therapy group. The eradication rate following one or two courses of eradication treatment was comparable in the two groups, as were the number of pulmonary exacerbations. However, the number of hospitalizations was significantly higher in the bronchoalveolar lavage-directed therapy group, but the mean duration of hospitalizations was significantly less compared to the standard therapy group.Mild adverse events were reported in a proportion of participants, but these were generally well-tolerated. The most common adverse event reported was transient worsening of cough after 29% of procedures. Significant clinical deterioration was documented during or within 24 hours of bronchoalveolar lavage in 4.8% of procedures.
AUTHORS' CONCLUSIONS
This review, limited to a single, well-designed randomized controlled study, shows no clear evidence to support the routine use of bronchoalveolar lavage for the diagnosis and management of pulmonary infection in pre-school children with cystic fibrosis compared to the standard practice of providing treatment based on results of oropharyngeal culture and clinical symptoms. No evidence was available for adult and adolescent populations.
Topics: Anti-Bacterial Agents; Bronchoalveolar Lavage; Bronchoscopy; Child, Preschool; Cystic Fibrosis; Humans; Infant; Pseudomonas Infections; Pseudomonas aeruginosa; Randomized Controlled Trials as Topic
PubMed: 30221745
DOI: 10.1002/14651858.CD009530.pub4 -
Antibiotics (Basel, Switzerland) Aug 2022(1) Background: Infections caused by multidrug-resistant (MDR) or extensively drug-resistant (XDR) bacteria represent a challenge in the neonatal population due to... (Review)
Review
(1) Background: Infections caused by multidrug-resistant (MDR) or extensively drug-resistant (XDR) bacteria represent a challenge in the neonatal population due to disease severity and limited therapeutic possibilities compared to adults. The spread of antimicrobial resistance and drug availability differ significantly worldwide. The incidence of MDR bacteria has constantly risen, causing an increase in morbidity, mortality, and healthcare costs in both high-income (HIC) and low- and middle-income countries (LMIC). Therefore, more evidence is needed to define the possible use of newer molecules and to optimize combination regimens for the oldest antimicrobials in neonates. This systematic review aims to identify and critically appraise the current antimicrobial treatment options and the relative outcomes for MDR and XDR Gram-negative bacterial infections in the neonatal population. (2) Methods: A literature search for the treatment of MDR Gram-negative bacterial infections in neonates (term and preterm) was conducted in Embase, MEDLINE, and Cochrane Library. Studies reporting data on single-patient-level outcomes related to a specific antibiotic treatment for MDR Gram-negative bacterial infection in children were included. Studies reporting data from adults and children were included if single-neonate-level information could be identified. We focused our research on four MDROs: producing extended-spectrum beta-lactamase (ESBL) or carbapenemase (CRE), and . PROSPERO registration: CRD42022346739 (3) Results: The search identified 11,740 studies (since January 2000), of which 22 fulfilled both the inclusion and exclusion criteria and were included in the analysis. Twenty of these studies were conducted in LMIC. Colistin is the main studied and used molecule to treat Gram-negative MDR bacteria for neonate patients in the last two decades, especially in LMIC, with variable evidence of efficacy. Carbapenems are still the leading antibiotics for ESBL , while newer molecules (i.e., beta-lactam agents/beta-lactamase inhibitor combination) are promising across all analyzed categories, but data are few and limited to HICs. (4) Conclusions: Data about the treatment of Gram-negative MDR bacteria in the neonatal population are heterogeneous and limited mainly to older antimicrobials. Newer drugs are promising but not affordable yet for many LMICs. Therefore, strategies cannot be generalized but will differ according to the country's epidemiology and resources. More extensive studies are needed to include new antimicrobials and optimize the combination strategies for the older ones.
PubMed: 36009956
DOI: 10.3390/antibiotics11081088 -
BMJ Open Respiratory Research Sep 2023Epidemiological information is essential in providing appropriate empiric antimicrobial therapy for pneumonia. This study aimed to clarify the epidemiology of...
OBJECTIVE
Epidemiological information is essential in providing appropriate empiric antimicrobial therapy for pneumonia. This study aimed to clarify the epidemiology of community-acquired pneumonia (CAP) by conducting a systematic review of published studies in Japan.
DESIGN
Systematic review.
DATA SOURCE
PubMed and Ichushi web database (January 1970 to October 2022).
ELIGIBILITY CRITERIA
Clinical studies describing pathogenic micro-organisms in CAP written in English or Japanese, excluding studies on pneumonia other than adult CAP, investigations limited to specific pathogens and case reports.
DATA EXTRACTION AND SYNTHESIS
Patient setting (inpatient vs outpatient), number of patients, concordance with the CAP guidelines, diagnostic criteria and methods for diagnosing pneumonia pathogens as well as the numbers of each isolate. A meta-analysis of various situations was performed to measure the frequency of each aetiological agent.
RESULTS
Fifty-six studies were included and 17 095 cases of CAP were identified. Pathogens were undetectable in 44.1% (95% CI 39.7% to 48.5%). was the most common cause of CAP requiring hospitalisation or outpatient care (20.0% (95% CI 17.2% to 22.8%)), followed by (10.8% (95% CI 7.3% to 14.3%)) and (7.5% (95% CI 4.6% to 10.4%)). However, when limited to CAP requiring hospitalisation, was the third most common at 4.9% (95% CI 3.9% to 5.8%). was more frequent in hospitalised cases, while atypical pathogens were less common. Methicillin-resistant accounted for 40.7% (95% CI 29.0% to 52.4%) of cases. In studies that used PCR testing for pan-respiratory viral pathogens, human enterovirus/human rhinovirus (9.4% (95% CI 0% to 20.5%)) and several other respiratory pathogenic viruses were detected. The epidemiology varied depending on the methodology and situation.
CONCLUSION
The epidemiology of CAP varies depending on the situation, such as in the hospital versus outpatient setting. Viruses are more frequently detected by exhaustive genetic searches, resulting in a significant variation in epidemiology.
PubMed: 37751988
DOI: 10.1136/bmjresp-2023-001800 -
The Cochrane Database of Systematic... Aug 2015Chronic pulmonary infection in cystic fibrosis results in progressive lung damage. Once colonisation of the lungs with Pseudomonas aeruginosa occurs, it is almost... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Chronic pulmonary infection in cystic fibrosis results in progressive lung damage. Once colonisation of the lungs with Pseudomonas aeruginosa occurs, it is almost impossible to eradicate. Vaccines, aimed at reducing infection with Pseudomonas aeruginosa, have been developed. This is an update of a previously published review.
OBJECTIVES
To assess the effectiveness of vaccination against Pseudomonas aeruginosa in cystic fibrosis.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register using the terms vaccines AND pseudomonas (last search 30 March 2015). We previously searched PubMed using the terms vaccin* AND cystic fibrosis (last search 30 May 2013).
SELECTION CRITERIA
Randomised trials (published or unpublished) comparing Pseudomonas aeruginosa vaccines (oral, parenteral or intranasal) with control vaccines or no intervention in cystic fibrosis.
DATA COLLECTION AND ANALYSIS
The authors independently selected trials, assessed them and extracted data.
MAIN RESULTS
Six trials were identified. Two trials were excluded since they were not randomised and one old, small trial because it was not possible to assess whether is was randomised. The three included trials comprised 483, 476 and 37 patients, respectively. No data have been published from one of the large trials, but the company stated in a press release that the trial failed to confirm the results from an earlier study and that further clinical development was suspended. In the other large trial, relative risk for chronic infection was 0.91 (95% confidence interval 0.55 to 1.49), and in the small trial, the risk was also close to one. In the large trial, one patient was reported to have died in the observation period. In that trial, 227 adverse events (4 severe) were registered in the vaccine group and 91 (1 severe) in the control group. In this large trial of a vaccine developed against flagella antigens, antibody titres against the epitopes contained in the vaccine were higher in the vaccine group compared to the placebo group (P < 0.0001).
AUTHORS' CONCLUSIONS
Vaccines against Pseudomonas aeruginosa cannot be recommended.
Topics: Cystic Fibrosis; Humans; Pseudomonas Infections; Pseudomonas Vaccines; Pseudomonas aeruginosa; Randomized Controlled Trials as Topic
PubMed: 26298311
DOI: 10.1002/14651858.CD001399.pub4