Interventions to reduce infections caused by multidrug resistant Enterobacteriaceae (MDR-E): A systematic review and meta-analysis. Issue 2 (August 2021)

• Record Type: Journal Article
• Authors: Atamna-Mawassi, Heyam; Huberman-Samuel, Maayan; hershcovitz, Shimrit; Karny-Epstein, Nitzan; Kola, Axel; Cortés, Luis Eduardo López; Leibovici, Leonard; Yahav, Dafna
• Is Part Of: Journal of infection. Volume 83:Issue 2(2021)
• Page Start: 156
• Page End: 166
• Publication Date: 2021-08
• Subjects: Infection prevention and control -- Multidrug resistant Enterobacteriaceae -- MDR-E -- Systematic review and meta-analysis; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2021.05.005
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: A systematic review and meta-analysis including 63 studies. Antimicrobial stewardship was found to reduce colonization with MDR-E, but not infection. Decolonization did not result in reduction of MDR-E infection or colonization. Abstract: Objectives: We aimed to evaluate different interventions to reduce multidrug-resistant Enterobacteriaceae (MDR-E) infection/colonization. Methods: A systematic review and meta-analysis evaluating interventions for prevention of MDR-E infection/colonization among hospitalized adult patients. The co-primary outcomes were mortality and MDR-E infections. PubMed, Cochrane library, and LILACS databases were searched up till December 2019, as well as grey literature sources. We included randomized controlled trials and observational studies. Infection/colonization/acquisition outcomes were reported per patient-days as pooled incidence ratios (IRs) with 95% confidence intervals (CIs). Interrupted time series (ITS) analysis studies were reported separately. Results: Sixty-three studies were included, 16 RCTs, 33 observational studies, and 14 ITS. For the intervention of antimicrobial stewardship program (ASP), 23 studies were included. No differences in mortality or MDR-E infections were observed with ASP, however, MDR-E colonization was significantly reduced (IR 0.69, 95% CI 0.57–0.82). Seventeen studies examined decolonization without significant difference in outcomes. Other interventions were scarcely represented. Among 14 ITS publications, most evaluating ASP, 11 showed benefit of the intervention. Conclusions: ASP is an effective measure in preventing MDR-E colonization. Decolonization did not show significant benefit in reducing infection or colonization. Studies are needed to evaluate the cost effectiveness of ASP and assess bundles of interventions.