JAC Advance Access originally published online on September 11, 2007
Journal of Antimicrobial Chemotherapy 2007 60(5):913-920; doi:10.1093/jac/dkm318
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Systematic reviews |
Mortality and delay in effective therapy associated with extended-spectrum ß-lactamase production in Enterobacteriaceae bacteraemia: a systematic review and meta-analysis
1 Division of Epidemiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel 2 Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Received 28 February 2007; returned 21 April 2007; revised 22 July 2007; accepted 31 July 2007
* Corresponding author. Tel: +972-52-4266800; Fax: +972-3-6973256; E-mail: mitchells{at}tasmc.health.gov.il
Objectives: We performed a systematic review and meta-analysis to examine the impact of extended-spectrum ß-lactamase (ESBL) production on mortality and delay in effective therapy in Enterobacteriaceae bacteraemia.
Methods: We searched the PubMed database using the terms ‘bacteremia or bloodstream’ and ‘ESBL or extended-spectrum beta-lactamase’. Included studies contained numbers of and mortality figures for patients with bacteraemia caused by ESBL producers and non-producers. Data extracted included crude relative risk (RR), adjusted odds ratio and 95% confidence intervals (CIs) for mortality and delayed effective therapy. Results were pooled using a random effects model.
Results: Sixteen studies met inclusion criteria. Meta-analysis of crude RRs demonstrated significantly increased mortality in ESBL-associated bacteraemia (pooled RR 1.85, 95% CI 1.39–2.47, P < 0.001). However, only one study reported RR controlled for confounding. Ten studies reported comparative data on delay in effective therapy. Meta-analysis of crude RRs demonstrated significantly increased incidence of delay in effective therapy in ESBL-associated bacteraemia (pooled RR 5.56, 95% CI 2.94–10.51, P < 0.001).
Conclusions: In Enterobacteriaceae bacteraemia, ESBL production is associated with increased mortality and delay in effective therapy. However, lack of controlled studies limits interpretation regarding causality, and further controlled studies are required.
Keywords: antimicrobial resistance , Gram-negative , outcomes , bloodstream infection
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