Antimicrobial resistance is a global threat that needs novel intervention strategies. The development of such strategies requires a determination of priority pathogens and settings. A recent study aimed to evaluate the excess health burden of drug-resistant bloodstream infections (BSIs) in Europe.
The study was a systematic review and meta-analysis that used data from MEDLINE, Embase, and grey literature for the period from January 1990 to May 2022. The criteria for study eligibility included studies that reported burden data for six key drug-resistant pathogens. These included carbapenem-resistant (CR) Pseudomonas aeruginosa and Acinetobacter baumannii, third-generation cephalosporin or CR Escherichia coli and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium. The selection also considered excess health outcomes compared with drug-susceptible BSIs or uninfected patients.
The study involved both pediatric and adult patients diagnosed with drug-resistant BSI. An adapted version of the Joanna-Briggs Institute assessment tool was used to assess the risk of bias. Random-effect models were then utilized to pool pathogen-specific burden estimates.
Out of the 7154 titles and 1078 full texts screened, 56 studies on BSIs were found. Most studies compared the outcomes of drug-resistant to drug-susceptible BSIs. It was found that drug-resistant BSIs are associated with increased mortality. The pooled crude estimate for excess all-cause mortality of drug-resistant versus drug-susceptible BSIs ranged from OR 1.31 for CR P. aeruginosa to OR 3.44 for CR K. pneumoniae. Pooled crude estimates comparing mortality to uninfected patients were available for vancomycin-resistant Enterococcus and MRSA BSIs.
In conclusion, the magnitude of the increased mortality associated with drug-resistant BSIs is influenced by the type of pathogen and comparator. Future research should aim to fill crucial knowledge gaps in pathogen- and infection-specific burdens to guide the development of novel interventions.
Original Article DOI: 10.1016/j.cmi.2023.09.001
Original title: A systematic review on the excess health risk of antibiotic-resistant bloodstream infections for six key pathogens in Europe
