Department of Medical Education and General Practice, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
Department of Infection Control Science, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
Emerg Microbes Infect. 2023 Dec;12(1):2217951. doi: 10.1080/22221751.2023.2217951.
Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) bacteremia can have poor clinical outcomes. Thus, determining the predictors of mortality from ESBL-PE bacteremia is very important. The present systematic review and meta-analysis aimed to evaluate studies to determine predictors associated with ESBL-PE bacteremia mortality. We searched PubMed and Cochrane Library databases for all relevant publications from January 2000 to August 2022. The outcome measure was mortality rate. In this systematic review of 22 observational studies, 4607 patients with ESBL-PE bacteremia were evaluated, of whom 976 (21.2%) died. The meta-analysis showed that prior antimicrobial therapy (RR, 2.89; 95% CI, 1.22-6.85), neutropenia (RR, 5.58; 95% CI, 2.03-15.35), nosocomial infection (RR, 2.46; 95% CI, 1.22-4.95), rapidly fatal underlying disease (RR, 4.21; 95% CI, 2.19-8.08), respiratory tract infection (RR, 2.12; 95% CI, 1.33-3.36), Pitt bacteremia score (PBS) (per1) (RR, 1.35; 95% CI, 1.18-1.53), PBS ≥ 4 (RR, 4.02; 95% CI, 2.77-5.85), severe sepsis (RR, 11.74; 95% CI, 4.68-29.43), and severe sepsis or septic shock (RR, 4.19; 95% CI, 2.83-6.18) were found to be mortality predictors. Moreover, urinary tract infection (RR, 0.15; 95% CI, 0.04-0.57) and appropriate empirical therapy (RR, 0.39; 95% CI, 0.18-0.82) were found to be a protective factor against mortality. Patients with ESBL-PE bacteremia who have the aforementioned require prudent management for improved outcomes. This research will lead to better management and improvement of clinical outcomes of patients with bacteremia caused by ESBL-PE.
产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-PE）菌血症可能有较差的临床结局。因此，确定 ESBL-PE 菌血症相关死亡率的预测因素非常重要。本系统评价和荟萃分析旨在评估研究以确定与 ESBL-PE 菌血症死亡率相关的预测因素。我们检索了 2000 年 1 月至 2022 年 8 月期间的 PubMed 和 Cochrane 图书馆数据库的所有相关出版物。结局测量为死亡率。在这项对 22 项观察性研究的系统评价中，评估了 4607 例 ESBL-PE 菌血症患者，其中 976 例（21.2%）死亡。荟萃分析显示，先前的抗菌治疗（RR，2.89；95%CI，1.22-6.85）、中性粒细胞减少症（RR，5.58；95%CI，2.03-15.35）、医院获得性感染（RR，2.46；95%CI，1.22-4.95）、快速致命的基础疾病（RR，4.21；95%CI，2.19-8.08）、呼吸道感染（RR，2.12；95%CI，1.33-3.36）、Pitt 菌血症评分（PBS）（每 1 分）（RR，1.35；95%CI，1.18-1.53）、PBS≥4（RR，4.02；95%CI，2.77-5.85）、严重脓毒症（RR，11.74；95%CI，4.68-29.43）和严重脓毒症或感染性休克（RR，4.19；95%CI，2.83-6.18）均被发现是死亡率的预测因素。此外，还发现尿路感染（RR，0.15；95%CI，0.04-0.57）和适当的经验性治疗（RR，0.39；95%CI，0.18-0.82）是降低死亡率的保护因素。具有上述特征的 ESBL-PE 菌血症患者需要谨慎管理以改善结局。这项研究将有助于更好地管理和改善 ESBL-PE 引起的菌血症患者的临床结局。
