Impact of antibiotic exposure on antibiotic-resistant Acinetobacter baumannii isolation in intensive care unit patients: a systematic review and meta-analysis.

Autor: De Blasiis MR; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy., Sciurti A; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy. Electronic address: antonio.sciurti@uniroma1.it., Baccolini V; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy., Isonne C; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy., Ceparano M; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy., Iera J; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy; Management and Health Laboratory, Institute of Management, Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Italy., De Vito C; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy., Marzuillo C; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy., Villari P; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy., Migliara G; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
Jazyk: angličtina
Zdroj: The Journal of hospital infection [J Hosp Infect] 2024 Jan; Vol. 143, pp. 123-139. Date of Electronic Publication: 2023 Nov 14.
DOI: 10.1016/j.jhin.2023.11.002
Abstrakt: Background: Acinetobacter baumannii (AB) poses a significant threat to critically ill patients in intensive care units (ICUs). Although an association between antibiotic exposure and resistant AB is reported in the literature, a synthesis of evidence in ICU patients is still lacking.
Aim: To summarize the evidence on the association between prior antibiotic exposure and the occurrence of resistant AB in ICU patients.
Methods: Online databases were searched for cohort and case-control studies providing data on the association of interest. Carbapenem/multidrug-resistant AB isolation was compared with non-isolation; carbapenem/multidrug-resistant AB was compared with carbapenem/antibiotic-susceptible AB; and extensively drug-resistant AB isolation was compared with non-isolation. Each comparison was subjected to a restricted maximum likelihood random-effects meta-analysis per antibiotic class, estimating pooled ORs. Stratified meta-analyses were performed by study design, outcome type and association-measure adjustment.
Findings: Overall, 25 high-quality studies were retrieved. Meta-analyses showed that carbapenem/multidrug-resistant AB isolation was associated with previous exposure to aminoglycosides, carbapenems, third-generation cephalosporines, glycylcyclines, and nitroimidazoles. Increased risk of isolation of carbapenem/multidrug-resistant AB isolation vs carbapenem/antibiotic-susceptible AB was shown for prior exposure to aminoglycosides, antipseudomonal penicillins, carbapenems, fluoroquinolones, glycopeptides, and penicillins. Third-generation cephalosporin exposure increased the risk of extensively drug-resistant AB isolation vs non-isolation.
Conclusion: This systematic review clarifies the role of antibiotic use in antibiotic-resistant AB spread in ICUs, although for some antibiotic classes the evidence is still uncertain due to the small number of adjusted analyses, methodological and reporting issues, and limited number of studies. Future studies need to be carried out with standardized methods and appropriate reporting of multivariable models.
(Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: