1Division of Pharmacy Practice, Faculty of Pharmaceutical Sciences,Ubon Ratchathani University,Ubon Ratchathani,Thailand.
3Faculty of Pharmacy,Silpakorn University,Nakorn Pathom,Thailand.
Infect Control Hosp Epidemiol. 2018 May;39(5):525-533. doi: 10.1017/ice.2018.58. Epub 2018 Mar 27.
OBJECTIVETo summarize the clinical burden (cumulative incidence, prevalence, case fatality rate and length of stay) and economic burden (healthcare cost) of healthcare-associated infections (HAIs) due to multidrug-resistant organisms (MDROs) among patients in intensive care units (ICUs) in Southeast Asia.DESIGNSystematic review.METHODSWe conducted a comprehensive literature search in PubMed, EMBASE, CINAHL, EconLit, and the Cochrane Library databases from their inception through September 30, 2016. Clinical and economic burdens and study quality were assessed for each included study.RESULTSIn total, 41 studies met our inclusion criteria; together, 22,876 ICU patients from 7 Southeast Asian countries were included. The cumulative incidence of HAI caused by A. baumannii (AB) in Southeast Asia is substantially higher than has been reported in other regions, especially carbapenem-resistant AB (CRAB; 64.91%) and multidrug-resistant AB (MDR-AB) (58.51%). Evidence of a dose-response relationship between different degrees of drug resistance and excess mortality due to AB infections was observed. Adjusted odds ratios were 1.23 (95% confidence interval [CI], 0.51-3.00) for MDR-AB, 1.72 (95% CI, 0.77-3.80) for extensively drug-resistant AB (XDR-AB), and 1.82 (95% CI, 0.55-6.00) for pandrug-resistant AB (PDR-AB). There is, however, a paucity of published data on additional length of stay and costs attributable to MDROs.CONCLUSIONSThis review highlights the challenges in addressing MDROs in Southeast Asia, where HAIs caused by MDR gram-negative bacteria are abundant and have a strong impact on society. With our findings, we hope to draw the attention of clinicians and policy makers to the problem of antibiotic resistance and to issue a call for action in the management of MDROs.Infect Control Hosp Epidemiol 2018;39:525-533.
总结东南亚重症监护病房（ICU）中多重耐药菌（MDRO）引起的医源性感染（HAI）的临床负担（累积发病率、患病率、病死率和住院时间）和经济负担（医疗保健费用）。
系统综述。
我们对 PubMed、EMBASE、CINAHL、EconLit 和 Cochrane 图书馆数据库进行了全面的文献检索，检索时间截至 2016 年 9 月 30 日。对每个纳入的研究进行了临床和经济负担以及研究质量评估。
共纳入 41 项研究，共纳入来自 7 个东南亚国家的 22876 例 ICU 患者。东南亚地区鲍曼不动杆菌（AB）引起的 HAI 累积发病率明显高于其他地区，尤其是耐碳青霉烯鲍曼不动杆菌（CRAB；64.91%）和多重耐药鲍曼不动杆菌（MDR-AB；58.51%）。观察到不同耐药程度与 AB 感染导致的超额死亡率之间存在剂量反应关系。调整后的优势比分别为 MDR-AB 1.23（95%可信区间[CI]，0.51-3.00）、广泛耐药鲍曼不动杆菌（XDR-AB）1.72（95% CI，0.77-3.80）和泛耐药鲍曼不动杆菌（PDR-AB）1.82（95% CI，0.55-6.00）。然而，关于 MDRO 导致的额外住院时间和费用的数据很少。
本综述强调了在东南亚地区应对 MDRO 面临的挑战，该地区 MDR 革兰氏阴性菌引起的 HAI 很普遍，对社会有很大影响。我们希望通过这些发现，引起临床医生和决策者对抗生素耐药性问题的关注，并呼吁采取行动来管理 MDRO。感染控制与医院流行病学 2018；39：525-533。
