Pezzani Maria Diletta, Arieti Fabiana, Rajendran Nithya Babu, Barana Benedetta, Cappelli Eva, De Rui Maria Elena, Galia Liliana, Hassoun-Kheir Nasreen, Argante Lorenzo, Schmidt Johannes, Rodriguez-Bano Jesus, Harbarth Stephan, de Kraker Marlieke, Gladstone Beryl Primrose, Tacconelli Evelina
Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
Clin Microbiol Infect. 2024 Mar;30 Suppl 1:S4-S13. doi: 10.1016/j.cmi.2023.10.019. Epub 2023 Nov 15.
To prioritize healthcare investments, ranking of infections caused by antibiotic-resistant bacteria should be based on accurate incidence data.
We performed a systematic review to estimate frequency measures of antimicrobial resistance for six key bacteria causing bloodstream infections (BSI) in European countries.
We searched PubMed, Web of Science, Embase databases, and the ECRAID-Base Epidemiological-Network platform.
We included studies and surveillance systems assessing resistance-percentage, prevalence, or incidence-density of BSI because of carbapenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli, third-generation cephalosporins-resistant E. coli and K. pneumoniae, vancomycin-resistant Enterococcus faecium, and methicillin-resistant Staphylococcus aureus.
Reviewers independently assessed published data and evaluated study quality with the modified Joanna Briggs Institute critical appraisal tool. Pooled estimates were determined using random effects meta-analysis. Consistency of data was assessed using random effects meta-regression (Wald test, p > 0.05).
We identified 271 studies and 52 surveillance systems from 32 European countries. Forty-five studies (16%) reported on BSI, including 180 frequency measures most commonly as resistance-percentage (88, 48.9%). Among 309 frequency measures extracted from 24 (46%) surveillance systems, 278 (89%) were resistance-percentages. Frequency measures of methicillin-resistant S. aureus and vancomycin-resistant E. faecium BSI were more frequently reported from Southern Europe and Western Europe (80%), whereas carbapenem-resistant P. aeruginosa BSI from Northern Europe and Western Europe (88%). Highest resistance-percentages were detected for carbapenem-resistant A. baumannii (66% in Central Eastern Europe) and carbapenem-resistant K. pneumoniae (62.8% in Southern Europe). Pooled estimates showed lower resistance-percentages in community versus healthcare-associated infections and in children versus adults. Estimates from studies and surveillance systems were mostly consistent among European regions. The included data was of medium quality.
Pathogen-specific frequency measures of antimicrobial resistance in BSI are insufficient to inform antibiotic stewardship and research and development strategies. Improving data collection and standardization of frequency measures is urgently needed.
为了优化医疗保健投资，对抗生素耐药菌引起的感染进行排名应基于准确的发病率数据。
我们进行了一项系统评价，以估计欧洲国家六种导致血流感染（BSI）的关键细菌的抗菌药物耐药性频率指标。
我们检索了PubMed、科学网、Embase数据库以及ECRAID-Base流行病学网络平台。
我们纳入了评估由耐碳青霉烯类铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌和大肠埃希菌、耐第三代头孢菌素的大肠埃希菌和肺炎克雷伯菌、耐万古霉素粪肠球菌以及耐甲氧西林金黄色葡萄球菌引起的BSI的耐药百分比、患病率或发病率密度的研究和监测系统。
评审员独立评估已发表的数据，并使用改良的乔安娜·布里格斯研究所批判性评价工具评估研究质量。采用随机效应荟萃分析确定合并估计值。使用随机效应元回归（Wald检验，p>0.05）评估数据的一致性。
我们从32个欧洲国家识别出271项研究和52个监测系统。45项研究（16%）报告了BSI，包括180个频率指标，最常见的是耐药百分比（88个，48.9%）。在从24个（46%）监测系统中提取的309个频率指标中，278个（89%）是耐药百分比。耐甲氧西林金黄色葡萄球菌和耐万古霉素粪肠球菌BSI的频率指标在南欧和西欧报告得更频繁（80%），而耐碳青霉烯类铜绿假单胞菌BSI在北欧和西欧报告得更频繁（88%）。耐碳青霉烯类鲍曼不动杆菌（中东欧为66%）和耐碳青霉烯类肺炎克雷伯菌（南欧为62.8%）的耐药百分比最高。合并估计显示，社区感染与医疗保健相关感染相比，以及儿童与成人相比，耐药百分比更低。研究和监测系统的估计值在欧洲各地区大多一致。纳入的数据质量中等。
BSI中病原体特异性抗菌药物耐药性频率指标不足以指导抗生素管理以及研发策略。迫切需要改进数据收集和频率指标的标准化。
