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Review
. 2018 Jun 28;5(7):ofy150.
doi: 10.1093/ofid/ofy150. eCollection 2018 Jul.

Association Between Carbapenem Resistance and Mortality Among Adult, Hospitalized Patients With Serious Infections Due to Enterobacteriaceae: Results of a Systematic Literature Review and Meta-analysis

Amber Martin  1 , Kyle Fahrbach  1 , Qi Zhao  2 , Thomas Lodise  3
Affiliations
Review

Association Between Carbapenem Resistance and Mortality Among Adult, Hospitalized Patients With Serious Infections Due to Enterobacteriaceae: Results of a Systematic Literature Review and Meta-analysis

Amber Martin et al. Open Forum Infect Dis. .

Abstract

This study quantified mortality associated with serious infections caused by carbapenem-resistant (CRE) and carbapenem-susceptible Enterobacteriaceae (CSE). A systematic literature review was conducted, evaluating outcomes in hospitalized patients with CRE infections from a blood, urinary, pulmonary, or intra-abdominal source. A meta-analysis (MA) calculating odds ratios (ORs) for mortality was performed. Twenty-two studies met the criteria for inclusion in the MA: 12 included mortality data for CRE vs CSE populations. Compared with CSE, CRE was associated with a significantly higher risk of overall mortality (OR, 3.39; 95% confidence interval [CI], 2.35-4.89), as was monotherapy (vs combination therapy) treatment of patients with CRE infections (OR, 2.19; 95% CI, 1.00-4.80). These results document the increased mortality associated with serious CRE infections compared with CSE infections among hospitalized adults. It will be important to reevaluate the mortality in CRE and CSE populations, especially among patients who receive early appropriate therapy, as new antibiotics become available.

Keywords: Klebsiella pneumoniae; bacterial drug resistance; carbapenems;; meta-analysis; mortality.

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Figures

Figure 1.
Figure 1.
Systematic literature search and review and study attrition. Abbreviations: CRE, carbapenem-resistant Enterobacteriaceae; RCT, randomized controlled trial. aRepresents 33 articles identified using electronic database search and 4 articles identified using manual reference checks.
Figure 2.
Figure 2.
Mortality in patients with CRE vs CSE infections. Abbreviations: CI, confidence interval; CRE, carbapenem-resistant Enterobacteriaceae; CSE, carbapenem- susceptible Enterobacteriaceae.
Figure 3.
Figure 3.
Mortality in patients with BSIs due to CRE vs CSE. Abbreviations: BSI, blood stream infection; CI, confidence interval; CRE, carbapenem-resistant Enterobacteriaceae; CSE, carbapenem-susceptible Enterobacteriaceae.
Figure 4.
Figure 4.
Mortality in patients with infections caused by CRKP vs CSKP. Abbreviations: CI, confidence interval; CRE, carbapenem-resistant Enterobacteriaceae; CSE, carbapenem-susceptible Enterobacteriaceae; CRKP, carbapenem-resistant Klebsiella pneumoniae; CSKP, carbapenem-susceptible K. pneumoniae.
Figure 5.
Figure 5.
Mortality in patients with KPC-producing CRE vs non-KPC-producing CSE infections. Abbreviations: CI, confidence interval; CRE, carbapenem-resistant Enterobacteriaceae; CSE, carbapenem-susceptible Enterobacteriaceae; KPC, Klebsiella pneumoniae carbapenemase.
Figure 6.
Figure 6.
Mortality in patients with CRE infections treated with monotherapy vs combination therapy. Abbreviations: CI, confidence interval; CRE, carbapenem-resistant Enterobacteriaceae.
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