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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.
Insights
Multidrug-resistant gram-negative bacteria (MDR-GNB) colonization leads to a 22% infection rate for extended-spectrum beta-lactamases (ESBL-E) and carbapenem-resistant Enterobacterales (CRE). This highlights a significant global health threat requiring further research into decolonization strategies.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Multidrug-resistant gram-negative bacteria (MDR-GNB), including extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) and carbapenem-resistant Enterobacterales (CRE), pose a significant global health risk.
- Colonization with these pathogens is a precursor to infection, necessitating an understanding of infection rates.
Purpose of the Study:
- To assess the quality of existing evidence on infection rates following MDR-GNB colonization.
- To provide pooled estimates for the incidence of infection after colonization with specific MDR-GNB, namely ESBL-E and CRE.
Main Methods:
- An umbrella review methodology was employed, analyzing systematic reviews and meta-analyses.
- The AMSTAR 2 tool was utilized to evaluate the quality of the included reviews.
- A meta-analysis was conducted to synthesize and estimate the rate of infection.
Main Results:
- Out of 847 initial results, 17 systematic reviews and meta-analyses were included after quality and overlap exclusions.
- The pooled incidence of infection following colonization was 22% for both ESBL-E and CRE.
- Limited high-quality data were available regarding mortality, transmission, or infections caused by MDR *Pseudomonas aeruginosa* and carbapenem-resistant *Acinetobacter baumannii*.
Conclusions:
- Colonization with MDR-GNB is associated with a substantial rate of subsequent infection.
- Findings can inform patient counseling, decolonization research, clinical trial design, and regulatory processes for new agents.
- Population heterogeneity in the reviewed studies may affect the generalizability of the findings.
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