School of Public Health, Patrick Manson Building (North Wing), 7 Sassoon Road, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China.
Bull World Health Organ. 2019 Jul 1;97(7):486-501B. doi: 10.2471/BLT.18.225698. Epub 2019 May 14.
To make a systematic review of risk factors, outcomes and prevalence of extended-spectrum β-lactamase-associated infection in children and young adults in South-East Asia and the Western Pacific.
Up to June 2018 we searched online databases for published studies of infection with extended-spectrum β-lactamase-producing Enterobacteriaceae in individuals aged 0-21 years. We included case-control, cohort, cross-sectional and observational studies reporting patients positive and negative for these organisms. For the meta-analysis we used random-effects modelling of risk factors and outcomes for infection, and meta-regression for analysis of subgroups. We mapped the prevalence of these infections in 20 countries and areas using available surveillance data.
Of 6665 articles scanned, we included 40 studies from 11 countries and areas in the meta-analysis. The pooled studies included 2411 samples testing positive and 2874 negative. A higher risk of infection with extended-spectrum β-lactamase-producing bacteria was associated with previous hospital care, notably intensive care unit stays (pooled odds ratio, OR: 6.5; 95% confidence interval, CI: 3.04 to 13.73); antibiotic exposure (OR: 4.8; 95% CI: 2.25 to 10.27); and certain co-existing conditions. Empirical antibiotic therapy was protective against infection (OR: 0.29; 95% CI: 0.11 to 0.79). Infected patients had longer hospital stays (26 days; 95% CI: 12.81 to 38.89) and higher risk of death (OR: 3.2; 95% CI: 1.82 to 5.80). The population prevalence of infection was high in these regions and surveillance data for children were scarce.
Antibiotic stewardship policies to prevent infection and encourage appropriate treatment are needed in South-East Asia and the Western Pacific.
系统评价东南亚和西太平洋地区儿童和青年中广泛耐药β-内酰胺酶相关感染的危险因素、结局和流行率。
截至 2018 年 6 月，我们检索了在线数据库，以获取关于 0-21 岁个体感染产超广谱β-内酰胺酶肠杆菌科的已发表研究。我们纳入了病例对照、队列、横断面和观察性研究，报告了这些生物体阳性和阴性的患者。对于危险因素和感染结局的荟萃分析，我们使用了感染的随机效应模型，对于亚组分析使用了荟萃回归。我们利用现有监测数据，在 20 个国家和地区绘制了这些感染的流行率图。
在 6665 篇文章中，我们对来自 11 个国家和地区的 40 项研究进行了荟萃分析。汇总研究包括 2411 例阳性样本和 2874 例阴性样本。与感染产超广谱β-内酰胺酶细菌相关的更高风险与先前的医院护理有关，特别是重症监护病房的停留（汇总优势比，OR：6.5；95%置信区间，CI：3.04 至 13.73）；抗生素暴露（OR：4.8；95%CI：2.25 至 10.27）；和某些共存疾病。经验性抗生素治疗可预防感染（OR：0.29；95%CI：0.11 至 0.79）。感染患者的住院时间更长（26 天；95%CI：12.81 至 38.89），死亡风险更高（OR：3.2；95%CI：1.82 至 5.80）。这些地区的感染人群流行率很高，而针对儿童的监测数据却很少。
需要在东南亚和西太平洋地区实施抗生素管理政策，以预防感染并鼓励合理治疗。
