Laboratório de Radioisótopos, Departamento de Análises Clinicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Laboratório de Diagnóstico Laboratorial e Microbiologia Clínica, Campus Centro-Oeste/Dona Lindu, Universidade Federal de São João del-Rei, Rua Sebastião Gonçalves Coelho, 400, Divinópolis, MG, 35501-293, Brazil.
Eur J Clin Microbiol Infect Dis. 2020 Aug;39(8):1427-1438. doi: 10.1007/s10096-020-03876-x. Epub 2020 Jun 12.
We conducted a systematic review and meta-analysis to determine the rate of polymyxin resistance among Acinetobacter baumannii isolates causing infection in hospitalized patients around the world during the period of 2010-2019. The systematic review was performed on September 1, 2019, using PubMed/MEDLINE, Scopus, and Web of Science; studies published after January 1, 2010, were selected. The data were summarized in tables, critically analyzed, and treated statistically using the RStudio® Software with Meta package and Metaprop Command. After applying exclusion factors, 41 relevant studies were selected from 969 articles identified on literature search. The overall rate of polymyxin-resistant A. baumannii (PRAB) related to hospitalized patients was estimated to be 13% (95% CI, 0.06-0.27), where a higher rate was observed in America (29%; 95% CI, 0.12-0.55), followed by Europe (13%; 95% CI, 0.02-0.52), and Asia (10%; 95% CI, 0.02-0.32). The extensive use of polymyxins on veterinary to control bacterial infection and growth promotion, as well as the resurgence in prescription and use of polymyxins in the clinics against carbapenem-resistant gram-negative bacteria, may have contributed to the increased incidence of PRAB. The findings of this meta-analysis revealed that the rate of PRAB recovered from hospitalized patients is distinctively high. Thus, action needs to be taken to develop strategies to combat the clinical incidence of PRAB-induced hospital infections.
我们进行了系统评价和荟萃分析，以确定 2010 年至 2019 年期间世界各地住院患者感染的鲍曼不动杆菌分离株中多粘菌素耐药率。系统评价于 2019 年 9 月 1 日在 PubMed/MEDLINE、Scopus 和 Web of Science 上进行，选择了 2010 年 1 月 1 日后发表的研究。数据汇总在表格中，使用 RStudio®软件和 Meta 包和 Metaprop 命令进行批判性分析和统计学处理。应用排除因素后，从文献检索中确定的 969 篇文章中选择了 41 篇相关研究。估计与住院患者相关的多粘菌素耐药鲍曼不动杆菌（PRAB）的总体率为 13%（95%CI，0.06-0.27），其中美洲的比率较高（29%；95%CI，0.12-0.55），其次是欧洲（13%；95%CI，0.02-0.52）和亚洲（10%；95%CI，0.02-0.32）。广泛用于兽医控制细菌感染和促进生长，以及在临床上重新使用和使用多粘菌素对抗碳青霉烯类耐药革兰氏阴性菌，可能导致 PRAB 的发生率增加。荟萃分析的结果表明，从住院患者中回收的 PRAB 率明显较高。因此，需要采取行动制定策略，以应对 PRAB 引起的医院感染的临床发生率。
