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Infection Risk Associated With Colonization by Multidrug-Resistant Gram-Negative Bacteria: An Umbrella Review and
Edwin Wilbur Woodhouse1, Majd Alsoubani2, David J Roach3
1Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA.
Background:
Infections following colonization of multidrug-resistant gram-negative bacteria (MDR-GNB), particularly Enterobacterales with extended-spectrum beta-lactamases (ESBL-E) or carbapenem-resistant Enterobacterales (CRE), represent a major global health threat. Our aim was to assess quality of evidence and provide estimates on rate of infection following colonization with multidrug-resistant gram-negative bacteria.
Methods:
We performed an umbrella review of systematic reviews and meta-analyses. Quality was assessed using the AMSTAR 2 tool, and a meta-analysis was performed to estimate rate of infection.
Results:
An initial search for systematic reviews and meta-analyses yielded 847 results, with 17 articles ultimately included. After exclusion of 2 studies for overlapping results and very low quality, the pooled incidence of infection following colonization across the studies was 22% for ESBL-E and 22% for CRE. Few reviews included high-quality findings on mortality or transmission following colonization. Additionally, only a limited number of reviews included findings related to MDR Pseudomonas aeruginosa or carbapenem-resistant Acinetobacter baumannii.
Conclusions:
Our results suggest a substantial rate of infection following colonization of multidrug-resistant gram-negative bacteria. These findings can inform individual patient counseling, future decolonization innovation, clinical trial design, and regulatory approval of new decolonization agents. However, the heterogeneity of the included populations may limit the generalizability of these findings.
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