{"id":23947,"date":"2023-05-28T04:23:00","date_gmt":"2023-05-27T20:23:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=23947"},"modified":"2023-05-28T20:56:23","modified_gmt":"2023-05-28T12:56:23","slug":"lancet-infect-dis%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%a4%9a%e9%87%8d%e8%80%90%e8%8d%af%e9%9d%a9%e5%85%b0%e9%98%b4%e6%80%a7%e6%9d%86%e8%8f%8c%e5%92%8c%e8%80%90%e4%b8%87%e5%8f%a4%e9%9c%89","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=23947","title":{"rendered":"[Lancet Infect Dis\u53d1\u8868\u8bba\u6587]\uff1a\u591a\u91cd\u8010\u836f\u9769\u5170\u9634\u6027\u6746\u83cc\u548c\u8010\u4e07\u53e4\u9709\u7d20\u80a0\u7403\u83cc\u643a\u5e26\u8005\u7684\u611f\u67d3\u53d1\u751f\u7387"},"content":{"rendered":"\n

ARTICLES|ONLINE FIRST<\/a><\/p>\n\n\n\n

Incidence of infection with multidrug-resistant Gram-negative bacteria and vancomycin-resistant enterococci in carriers: a systematic review and meta-regression analysis<\/h1>\n\n\n\n

Roel P J Willems, Karin van Dijk, Maria J G T Vehreschild, et al<\/h3>\n\n\n\n

Lancet Infect Dis Published:January 30, 2023<\/h3>\n\n\n\n

DOI:https:\/\/doi.org\/10.1016\/S1473-3099(22)00811-8<\/a><\/h3>\n\n\n\n

Summary<\/h2>\n\n\n\n

Background<\/h3>\n\n\n\n

Carriers of multidrug-resistant bacteria are at risk of infections with these bacteria; the precise size of this risk is unclear. We aimed to quantify the effect of gut colonisation on subsequent risk of infection with multidrug-resistant bacteria.<\/p>\n\n\n\n

Methods<\/h3>\n\n\n\n

We performed a systematic review and meta-regression analysis. We searched PubMed, Embase, Web of Science Core Collection, and Google Scholar for follow-up studies published from Jan 1, 1995, to March 17, 2022, that measured the incidence of infections with multidrug-resistant Gram-negative bacteria (MDR-GNB) and from Jan 1, 1995, to March 15, 2022, that measured the incidence of infections with vancomycin-resistant enterococci (VRE). We included original cohort studies and case-control studies that used incidence-density sampling, included 50 or more patients with enteric colonisation or positive urinary samples as a surrogate marker of colonisation, or both, and analysed infections clearly preceded by colonisation. We did not use any language restrictions. We excluded studies not reporting length of follow-up. Summary data were extracted and independently cross-verified by two authors. Carriage was defined as MDR-GNB or VRE, detected in faecal or urinary cultures. Our primary outcomes were cumulative incidence and incidence density of infection in patients colonised by multidrug-resistant bacteria. To estimate pooled incidences, general linearised mixed-effects meta-regressions were used, adjusting for varying follow-up durations. This study is registered with PROSPERO, CRD42020222415.<\/p>\n\n\n\n

Findings<\/h3>\n\n\n\n

Of the 301 studies identified, 44 studies (26 on MDR-GNB, 14 on VRE, and four on both MDR-GNB and VRE) from 14 countries were retained for qualitative synthesis, 40 of which were analysed with meta-regression, comprising data for 14\u2009049 patients colonised with multidrug-resistant bacteria. The pooled cumulative incidence of infection was 14% (95% CI 10\u201318; p<0\u00b70001) at a median follow-up time of 30 days for MDR-GNB (845 cases of infection in 9034 patients colonised) and 8% (5\u201313; p<0\u00b70001) at 30 days for VRE (229 cases of infection in 4747 patients colonised). Infection incidence density (4\u00b726 infections per 1000 patient-days; 95% CI 1\u00b769\u20136\u00b782) and cumulative incidence of infection (19%, 95% CI 15\u201325; p<0\u00b70001; 602 cases of infection in 4547 patients colonised) were highest for carbapenem-resistant Gram-negative bacteria at 30 days. Risk of bias was rated low to moderate.<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Interpretation<\/h3>\n\n\n\n

The risk of infection was substantial, with the highest risk for patients colonised with carbapenem-resistant Gram-negative bacteria and the lowest in patients with VRE. These data might help to guide prophylactic and treatment decisions and form a valuable resource for planning clinical trials on targeted prevention.<\/p>\n\n\n\n

Funding<\/h3>\n\n\n\n

The Netherlands Organization for Health Research and Development<\/p>\n","protected":false},"excerpt":{"rendered":"

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