Impact of carbapenem resistance on mortality in patients infected with Enterobacteriaceae : a systematic review and meta-analysis

作者：Ruyin Zhou, Xiangming Fang, Jinjin Zhang, Xiaodong Zheng, Shuangyue Shangguan, Shibo Chen, Yingbo Shen, Zhihai Liu, Juan Li, Rong Zhang, Jianzhong Shen, Timothy R. Walsh, Yang Wang · 发表于：BMJ Open · 年份：2021 · DOI：10.1136/bmjopen-2021-054971 · 被引用次数：99 · 研究领域：Antibiotic Resistance in Bacteria、Antibiotics Pharmacokinetics and Efficacy、Antibiotic Use and Resistance

Objectives To provide a comprehensive assessment of the impact of carbapenem resistance on mortality among patients infected with Enterobacteriaceae and to explore the source of heterogeneity across studies. Design This systematic review was conducted following the guidelines of Cochrane Guidance and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data sources We conducted a systematic literature search of the PubMed, Embase, Web of Science and Cochrane Library databases to identify relevant studies published between 1 January 1994 and 30 August 2020. Eligibility criteria We included primary observational studies published in English that reported the mortality outcomes for hospitalised patients with confirmed infections due to carbapenem-resistant Enterobacteriaceae (CRE) and carbapenem-susceptible Enterobacteriaceae (CSE). Studies with no comparison group or with a comparison group of patients infected with unconfirmed CSE were excluded. Data extraction and synthesis Data extraction and assessment of risk bias were conducted independently by two reviewers. The pooled relative risk and risk difference were calculated as effect measures with 95% CIs using a random effects model. The heterogeneity across studies was assessed by Q-statistic and I 2 measures. Results Of 10 304 studies initially identified, 50 studies were included in the meta-analyses. The results of the meta-analyses showed that carbapenem resistance has a significant positive effect on ...