Anti-Infective Evasion and Pharmacoepidemiology Team, Center for Epidemiology and Population Health, Université Paris-Saclay, UVSQ, INSERM, Montigny-le-Bretonneux, France.
Epidemiology and Modelling of Antibiotic Evasion, Institut Pasteur, Université Paris Cité, Paris, France.
JAMA Netw Open. 2024 Nov 4;7(11):e2441596. doi: 10.1001/jamanetworkopen.2024.41596.
In low- and middle-income countries (LMICs), neonatal bacterial infections are mainly caused by Enterobacterales species and Staphylococcus aureus, which are also the leading causes of mortality directly attributable to antimicrobial resistance. As bacterial colonization often precedes infection, better knowledge of colonization is crucial to prevent antibiotic-resistant neonatal sepsis.
To synthesize current evidence on the prevalence of and factors associated with colonization with third-generation cephalosporin-resistant Enterobacterales (3GCRE), carbapenem-resistant Enterobacterales (CRE), and methicillin-resistant S aureus (MRSA) during the first 3 months of life in LMICs.
PubMed, Scopus, Web of Science, and the World Health Organization Global Index Medicus were searched for articles published from January 1, 2000, through July 29, 2024.
Included studies were conducted in LMICs and reported prevalence rates or factors associated with colonization with 3GCRE, CRE, or MRSA in neonates and infants up to 3 months of age. Outbreak reports were excluded.
Data extraction and risk-of-bias assessment using a Joanna Briggs Institute tool were performed by 2 independent reviewers. Pooled prevalence for each pathogen was computed using a random-effects model. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.
Prevalence of and factors associated with 3GCRE, CRE, and MRSA colonization.
Of the 3147 articles identified in the search, 67 studies (51 for 3GCRE and CRE and 16 for MRSA) including 17 152 individuals were eligible. The pooled prevalence of 3GCRE colonization was 30.2% (95% CI, 21.4%-40.7%; τ2 = 1.48; I2 = 95.1%), varying from 18.2% (95% CI, 10.8%-29.1%) in nonhospitalized individuals to 48.2% (95% CI, 36.4%-60.2%) in hospitalized individuals. The prevalence of CRE colonization was 2.6% (95% CI, 0.7%-8.8%; τ2 = 7.79; I2 = 95.6%), while it was 2.7% (95% CI, 1.0%-6.7%; τ2 = 2.58; I2 = 93.5%) for MRSA. Increased risk of colonization with 3GCRE was associated with hospital birth (odds ratio [OR], 1.87; 95% CI, 1.33-2.64), neonatal antibiotic use (OR, 2.96; 95% CI, 1.43-6.11), and prolonged rupture of membranes (OR, 3.86; 95% CI, 2.19-6.84).
In this systematic review and meta-analysis of antibiotic-resistant pathogen carriage in individuals aged 0 to 3 months, the pooled prevalence was substantial despite a limited exposure period. Although high heterogeneity between studies limited extrapolation of results, the findings highlight the need for further investigation to identify transmission routes and to design targeted and effective preventive measures.
在中低收入国家（LMICs），新生儿细菌感染主要由肠杆菌科和金黄色葡萄球菌引起，这也是与抗生素耐药直接相关的主要死亡原因。由于细菌定植通常先于感染，因此更好地了解定植情况对于预防抗生素耐药性新生儿败血症至关重要。
综合目前关于 LMICs 中第三代头孢菌素耐药肠杆菌科（3GCRE）、碳青霉烯耐药肠杆菌科（CRE）和耐甲氧西林金黄色葡萄球菌（MRSA）定植的流行率及其相关因素的证据。
从 2000 年 1 月 1 日至 2024 年 7 月 29 日，通过 PubMed、Scopus、Web of Science 和世界卫生组织全球索引医学进行了文献检索。
纳入的研究在 LMICs 进行，并报告了在新生儿和 3 个月大的婴儿中 3GCRE、CRE 或 MRSA 定植的流行率或相关因素。排除了暴发报告。
由 2 名独立评审员使用 Joanna Briggs 研究所工具进行数据提取和偏倚风险评估。使用随机效应模型计算每个病原体的汇总流行率。报告遵循系统评价和荟萃分析的首选报告项目指南。
3GCRE、CRE 和 MRSA 定植的流行率及相关因素。
在搜索中确定的 3147 篇文章中，有 67 项研究（51 项针对 3GCRE 和 CRE，16 项针对 MRSA）包括 17152 名个体符合条件。3GCRE 定植的汇总流行率为 30.2%（95%CI，21.4%-40.7%；τ2=1.48；I2=95.1%），从非住院个体的 18.2%（95%CI，10.8%-29.1%）到住院个体的 48.2%（95%CI，36.4%-60.2%）不等。CRE 定植的流行率为 2.6%（95%CI，0.7%-8.8%；τ2=7.79；I2=95.6%），而 MRSA 为 2.7%（95%CI，1.0%-6.7%；τ2=2.58；I2=93.5%）。3GCRE 定植的风险增加与医院分娩（比值比[OR]，1.87；95%CI，1.33-2.64）、新生儿使用抗生素（OR，2.96；95%CI，1.43-6.11）和延长胎膜破裂时间（OR，3.86；95%CI，2.19-6.84）有关。
在这项关于个体 0 至 3 个月抗生素耐药病原体携带情况的系统评价和荟萃分析中，尽管暴露期有限，但汇总流行率仍然很高。尽管研究之间的高度异质性限制了结果的推断，但这些发现强调了需要进一步调查以确定传播途径，并设计有针对性和有效的预防措施。
