JAC Advance Access published online on September 11, 2007
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm318
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Systematic review |
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.
Key Words: antimicrobial resistance , Gram-negative , outcomes , bloodstream infection
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  E. Tacconelli, G. De Angelis, M. A. Cataldo, E. Mantengoli, T. Spanu, A. Pan, G. Corti, A. Radice, L. Stolzuoli, S. Antinori, et al. Antibiotic Usage and Risk of Colonization and Infection with Antibiotic-Resistant Bacteria: a Hospital Population-Based Study Antimicrob. Agents Chemother., October 1, 2009; 53(10): 4264 - 4269. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Livermore Has the era of untreatable infections arrived? J. Antimicrob. Chemother., September 1, 2009; 64(suppl_1): i29 - i36. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Schwaber and Y. Carmeli Carbapenem-Resistant Enterobacteriaceae: A Potential Threat JAMA, December 24, 2008; 300(24): 2911 - 2913. [Full Text] [PDF]
|
|
|
|
|
|
H. Sahly, S. Navon-Venezia, L. Roesler, A. Hay, Y. Carmeli, R. Podschun, C. Hennequin, C. Forestier, and I. Ofek Extended-Spectrum {beta}-Lactamase Production Is Associated with an Increase in Cell Invasion and Expression of Fimbrial Adhesins in Klebsiella pneumoniae Antimicrob. Agents Chemother., September 1, 2008; 52(9): 3029 - 3034. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Tumbarello, M. Sali, E. M. Trecarichi, F. Leone, M. Rossi, B. Fiori, G. De Pascale, T. D'Inzeo, M. Sanguinetti, G. Fadda, et al. Bloodstream Infections Caused by Extended-Spectrum-{beta}-Lactamase- Producing Escherichia coli: Risk Factors for Inadequate Initial Antimicrobial Therapy Antimicrob. Agents Chemother., September 1, 2008; 52(9): 3244 - 3252. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. G. Zhanel, M. DeCorby, N. Laing, B. Weshnoweski, R. Vashisht, F. Tailor, K. A. Nichol, A. Wierzbowski, P. J. Baudry, J. A. Karlowsky, et al. Antimicrobial-Resistant Pathogens in Intensive Care Units in Canada: Results of the Canadian National Intensive Care Unit (CAN-ICU) Study, 2005-2006 Antimicrob. Agents Chemother., April 1, 2008; 52(4): 1430 - 1437. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. G. Giske, D. L. Monnet, O. Cars, Y. Carmeli, and on behalf of ReAct-Action on Antibiotic Resistance Clinical and Economic Impact of Common Multidrug-Resistant Gram-Negative Bacilli Antimicrob. Agents Chemother., March 1, 2008; 52(3): 813 - 821. [Full Text] [PDF]
|
|