Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies

• Published in: Emerging microbes & infections Vol. 5; no. 1; pp. 1 - 6
• Main Authors: Zhang, Yu, Chen, Xiao-Li, Huang, Ai-Wei, Liu, Su-Ling, Liu, Wei-Jiang, Zhang, Ni, Lu, Xu-Zai
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis Ltd 23.03.2016; Nature Publishing Group; Taylor & Francis Group
• Subjects: Anti-Bacterial Agents - pharmacology; Antibiotics; Bacteremia - microbiology; Bacteremia - mortality; carbapenem resistance; Carbapenems - pharmacology; cohort; Cohort analysis; Cohort Studies; Drug Resistance, Bacterial; Humans; Meta-analysis; Microbial Sensitivity Tests; Mortality; Odds Ratio; Original; P. aeruginosa bacteremia; Prospective Studies; Pseudomonas aeruginosa - drug effects; Pseudomonas Infections - microbiology; Pseudomonas Infections - mortality; Retrospective Studies; Risk Factors
• ISSN: 2222-1751; 2222-1751
• DOI: 10.1038/emi.2016.22

Whether carbapenem resistance is associated with mortality in patients with Pseudomonas aeruginosa bacteremia is controversial. To address this issue, we conducted a systematic review and meta-analysis based on cohort studies. We searched PubMed and Embase databases to identify articles (up to April 2015). The DerSimonian and Laird random-effect model was used to generate a summary estimate of effect. Associations were evaluated in subgroups based on different patient characteristics and study quality criteria. Seven studies with a total of 1613 patients were finally included, of which 1 study had a prospective design, and the other 6 were retrospective. Our meta-analysis showed patients with carbapenem-resistant P. aeruginosa bacteremia were at a higher risk of death compared with those with carbapenem-susceptible P. aeruginosa bloodstream infections (pooled odds ratio (OR) from three studies reporting adjusted ORs: 3.07, 95% confidence interval (CI), 1.60-5.89; pooled OR from 4 studies only reporting crude ORs: 1.46, 95% CI, 1.10-1.94). The results were robust across a number of stratified analyses and a sensitivity analysis. We also calculated that 8%-18.4% of deaths were attributable to carbapenem resistance in four studies assessing the outcome with 30-day mortality, and these were 3% and 14.6%, respectively, in two studies using 7-day mortality or mortality during bacteremia as an outcome of interest. Carbapenem resistance had a deleterious impact on the mortality of P. aeruginosa bacteremia; however, the results should be interpreted cautiously because only three studies reporting adjusted ORs were included. More large-scale, well-designed prospective cohorts, as well as mechanistic studies, are urgently needed in the future.