TY - JOUR
T1 - Mortality and delay in effective therapy associated with extended-spectrum β-lactamase production in Enterobacteriaceae bacteraemia
T2 - A systematic review and meta-analysis
AU - Schwaber, Mitchell J.
AU - Carmeli, Yehuda
N1 - Funding Information:
This study was funded by a grant from the United States-Israel Binational Science Foundation. The Foundation had no role in the design or conduct of any aspect of the study.
PY - 2007/11
Y1 - 2007/11
N2 - Objectives: We performed a systematic review and meta-analysis to examine the impact of extended-spectrum β-lactamase (ESBL) production on mortality and delay in effective therapy in Enterobacteriaceae bacteraemia. Methods: We searched the PubMed database using the terms 'bacteremia or bloodstream' and 'ESBL or extended-spectrum beta-lactamase'. Included studies contained numbers of and mortality figures for patients with bacteraemia caused by ESBL producers and non-producers. Data extracted included crude relative risk (RR), adjusted odds ratio and 95% confidence intervals (CIs) for mortality and delayed effective therapy. Results were pooled using a random effects model. Results: Sixteen studies met inclusion criteria. Meta-analysis of crude RRs demonstrated significantly increased mortality in ESBL-associated bacteraemia (pooled RR 1.85, 95% CI 1.39-2.47, P < 0.001). However, only one study reported RR controlled for confounding. Ten studies reported comparative data on delay in effective therapy. Meta-analysis of crude RRs demonstrated significantly increased incidence of delay in effective therapy in ESBL-associated bacteraemia (pooled RR 5.56, 95% CI 2.94-10.51, P < 0.001). Conclusions: In Enterobacteriaceae bacteraemia, ESBL production is associated with increased mortality and delay in effective therapy. However, lack of controlled studies limits interpretation regarding causality, and further controlled studies are required.
AB - Objectives: We performed a systematic review and meta-analysis to examine the impact of extended-spectrum β-lactamase (ESBL) production on mortality and delay in effective therapy in Enterobacteriaceae bacteraemia. Methods: We searched the PubMed database using the terms 'bacteremia or bloodstream' and 'ESBL or extended-spectrum beta-lactamase'. Included studies contained numbers of and mortality figures for patients with bacteraemia caused by ESBL producers and non-producers. Data extracted included crude relative risk (RR), adjusted odds ratio and 95% confidence intervals (CIs) for mortality and delayed effective therapy. Results were pooled using a random effects model. Results: Sixteen studies met inclusion criteria. Meta-analysis of crude RRs demonstrated significantly increased mortality in ESBL-associated bacteraemia (pooled RR 1.85, 95% CI 1.39-2.47, P < 0.001). However, only one study reported RR controlled for confounding. Ten studies reported comparative data on delay in effective therapy. Meta-analysis of crude RRs demonstrated significantly increased incidence of delay in effective therapy in ESBL-associated bacteraemia (pooled RR 5.56, 95% CI 2.94-10.51, P < 0.001). Conclusions: In Enterobacteriaceae bacteraemia, ESBL production is associated with increased mortality and delay in effective therapy. However, lack of controlled studies limits interpretation regarding causality, and further controlled studies are required.
KW - Antimicrobial resistance
KW - Bloodstream infection
KW - Gram-negative
KW - Outcomes
UR - http://www.scopus.com/inward/record.url?scp=35448972600&partnerID=8YFLogxK
U2 - 10.1093/jac/dkm318
DO - 10.1093/jac/dkm318
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C2 - 17848376
AN - SCOPUS:35448972600
SN - 0305-7453
VL - 60
SP - 913
EP - 920
JO - Journal of Antimicrobial Chemotherapy
JF - Journal of Antimicrobial Chemotherapy
IS - 5
ER -