TY - JOUR
T1 - Clinical impact of active screening cultures for carbapenem-resistant Acinetobacter baumannii
T2 - A systematic review and meta-analysis
AU - Margalit, Ili
AU - Kunwar, Digbijay
AU - Gadot, Chen
AU - Meroi, Marco
AU - Scardellato, Rebecca
AU - Zamir, Amber
AU - Koutsolioutsou, Anastasia
AU - Goldberg, Elad
AU - Righi, Elda
AU - Yahav, Dafna
N1 - Publisher Copyright:
© 2024 Association for Professionals in Infection Control and Epidemiology, Inc.
PY - 2024/12
Y1 - 2024/12
N2 - Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a significant health care-associated infection carrying substantial mortality. We assessed the clinical impact of active screening cultures for CRAB. Methods: A systematic review and meta-analysis, aiming to answer 2 questions: (1) Does screening versus no screening improve clinical outcomes? (2) Does positive screening (“CRAB carrier”) predict CRAB infections? We searched the literature until January 2024 for comparative studies reporting clinical outcomes (mortality, invasive CRAB infections). Results: Of 5,407 screened publications, 9 studies (10,865 individuals) were included. Invasive CRAB infection rate was significantly higher among CRAB carriers (OR 11.14, 95% CI 4.95-25.05, with substantial heterogeneity stemming from size rather than direction of the effect). Negative predictive value of noncarriage for invasive infection was 97%. CRAB bloodstream infection rate was significantly higher among carriers (odds ratio 16.23, 95% confidence interval 2.9-110.08). No difference was demonstrated between the groups for CRAB ventilator-associated pneumonia, length of stay, and mortality. Only 1 study reported outcomes for study question #1. Conclusions: Data to support active CRAB screening are scarce regarding its clinical benefit for patients. Positively screened patients are at significantly higher risk for invasive CRAB infections, with high negative predictive value for noncarriage. This did not translate to reduced mortality.
AB - Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a significant health care-associated infection carrying substantial mortality. We assessed the clinical impact of active screening cultures for CRAB. Methods: A systematic review and meta-analysis, aiming to answer 2 questions: (1) Does screening versus no screening improve clinical outcomes? (2) Does positive screening (“CRAB carrier”) predict CRAB infections? We searched the literature until January 2024 for comparative studies reporting clinical outcomes (mortality, invasive CRAB infections). Results: Of 5,407 screened publications, 9 studies (10,865 individuals) were included. Invasive CRAB infection rate was significantly higher among CRAB carriers (OR 11.14, 95% CI 4.95-25.05, with substantial heterogeneity stemming from size rather than direction of the effect). Negative predictive value of noncarriage for invasive infection was 97%. CRAB bloodstream infection rate was significantly higher among carriers (odds ratio 16.23, 95% confidence interval 2.9-110.08). No difference was demonstrated between the groups for CRAB ventilator-associated pneumonia, length of stay, and mortality. Only 1 study reported outcomes for study question #1. Conclusions: Data to support active CRAB screening are scarce regarding its clinical benefit for patients. Positively screened patients are at significantly higher risk for invasive CRAB infections, with high negative predictive value for noncarriage. This did not translate to reduced mortality.
KW - Hospital epidemiology
KW - Infection control
KW - Multidrug resistance
KW - Sepsis
UR - http://www.scopus.com/inward/record.url?scp=85198080875&partnerID=8YFLogxK
U2 - 10.1016/j.ajic.2024.06.017
DO - 10.1016/j.ajic.2024.06.017
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
C2 - 38936479
AN - SCOPUS:85198080875
SN - 0196-6553
VL - 52
SP - 1351
EP - 1358
JO - American Journal of Infection Control
JF - American Journal of Infection Control
IS - 12
ER -
