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. 2022 Oct;35(5):455-467.
doi: 10.37201/req/062.2022. Epub 2022 Jul 21.

A systematic literature review and expert consensus on risk factors associated to infection progression in adult patients with respiratory tract or rectal colonisation by carbapenem-resistant Gram-negative bacteria

R Ferrer, A Soriano, R Cantón, J L Del Pozo, C García-Vidal, J Garnacho-Montero, N Larrosa, P Rascado, M Salavert, V Pintado, N Giró-Perafita, X Badia  1
Affiliations

A systematic literature review and expert consensus on risk factors associated to infection progression in adult patients with respiratory tract or rectal colonisation by carbapenem-resistant Gram-negative bacteria

R Ferrer et al. Rev Esp Quimioter. 2022 Oct.

Abstract
in English, Spanish

Objective: Risk factors (RFs) associated with infection progression in patients already colonised by carbapenem-resistant Gram-negative bacteria (CRGNB) have been addressed in few and disperse works. The aim of this study is to identify the relevant RFs associated to infection progression in patients with respiratory tract or rectal colonisation.

Methods: A systematic literature review was developed to identify RFs associated with infection progression in patients with CRGNB respiratory tract or rectal colonisation. Identified RFs were then evaluated and discussed by the expert panel to identify those that are relevant according to the evidence and expert's experience.

Results: A total of 8 articles were included for the CRGNB respiratory tract colonisation and 21 for CRGNB rectal colonisation, identifying 19 RFs associated with pneumonia development and 44 RFs associated with infection progression, respectively. After discussion, the experts agreed on 13 RFs to be associated with pneumonia development after respiratory tract CRGNB colonisation and 33 RFs to be associated with infection progression after rectal CRGNB colonisation. Respiratory tract and rectal colonisation, previous stay in the ICU and longer stay in the ICU were classified as relevant RF independently of the pathogen and site of colonisation. Previous exposure to antibiotic therapy or previous carbapenem use were also common relevant RF for patients with CRGNB respiratory tract and rectal colonisation.

Conclusions: The results of this study may contribute to the early identification of CRGNB colonized patients at higher risk of infection development, favouring time-to-effective therapy and improving health outcomes.

Objetivo: Los factores de riesgo (FR) asociados a la progresión de la infección en pacientes ya colonizados por bacterias gramnegativas resistentes a carbapenémicos (BGNRC) han sido abordados en pocos y dispersos trabajos. El objetivo de este estudio es identificar los factores de riesgo relevantes asociados a la progresión de la infección en pacientes con colonización del tracto respiratorio o rectal.

Material y métodos: Se realizó una revisión sistemática de la literatura para identificar los FR asociados a la progression de la infección en pacientes con colonización del tracto respiratorio o rectal por BGNRC. Los FR identificados fueron luego evaluados y discutidos por el panel de expertos para identificar aquellos que son relevantes según la evidencia disponible y la experiencia de los expertos.

Resultados: Un total de 8 artículos fueron incluidos en el análisis de los FR en la colonización del tracto respiratorio y 21 para la colonización rectal, identificándose 19 FR asociados al desarrollo de neumonía y 44 FR asociados a la progresión de la infección respectivamente. Tras la sesión de discusión, los expertos acordaron que 13 FR se asociaban al desarrollo de neumonía tras la colonización del tracto respiratorio por BGNRC y 33 FR a la progresión de la infección tras la colonización rectal por BGNRC. La colonización del tracto respiratorio y rectal, la estancia previa en la UCI y una estancia prolongada en la UCI se clasificaron como FR relevantes independientemente del patógeno y del lugar de colonización. La exposición previa a antibióticos o el uso previo de carbapenémicos se clasificaron como FR relevantes para varios de los patógenos tanto en pacientes con colonización del tracto respiratorio como rectal.

Conclusión: Los resultados de este estudio pueden contribuir a la identificación precoz de los pacientes colonizados por BGNRC con mayor riesgo de desarrollo de infección, favoreciendo el uso temprano de terapias efectivas y mejorar los resultados en salud de estos pacientes.

Keywords: Carbapenem-resistant gram-negative bacteria; Multi-drug resistance; Risk factor; colonization; expert consensus.

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Conflict of interest statement

RF has participated as a speaker or consultant for MSD, Pfizer, Shionogi, Gilead, Grifols and Menarini. AS has participated in advisory meetings or as a speaker in educational activities for Pfizer, MSD, Angelini, Gilead Sciences and Shionogi. RC has participated in education activities organised by MSD, Pfizer and Shionogi and worked on research projects funded by MSD, Shionogi and Venatrox. JLP has participated in education activities and advisory meetings organised by Novartis, MSD, Pfizer and Gilead, Angelini and Shionogi and worked on research projects funded by Novartis. CG-V has received honoraria for talks on behalf of Gilead Science, MSD, Novartis, Pfizer, Janssen, Lilly, Shionogi as well as a grant from Gilead Science, Pfizer and MSD. JG-M has participated as a speaker in educational activities for MSD, Pfizer and Shionogi. NL has participated in advisory meetings or as a speaker in educational activities funded by Pfizer, MSD, Menarini and Shionogi. PR has participated as consultant and speaker in educational activities organized by Pizer, MSD, Menarini and Shionogi. MS has collaborated in training or research projects and taken part in symposia, meetings or consultancies organised or funded by Gilead, MSD, Janssen, Pfizer and Shionogi. VP has participated in accredit ed educational activities sponsored by MSD, Pfizer and Shionogi and has been a consultant for Pfizer, Shionogi and Correvio. AG-P and XB are employees of Omakase Consulting S.L. that received funding from Shionogi Inc. to develop and conduct this study.

Figures

Figure 1
Figure 1
Systematic Literature Review search strategy
Figure 2
Figure 2
PRISM diagram of literature review results for A. Respiratory tract CRGNB colonization and B. rectal CRGNB colonization.
Figure 3
Figure 3
Scoring and results of the assessment of risk factors associated with pneumonia progression after CRGNB respiratory tract colonization in ICU adult inpatients with mechanical ventilation. Scores are represented according to the percentage of responses on the 1- I agree, 2-moderately agree and 3- do not agree. Result column shows if the risk factor was included as relevant, not relevant, or needed to be discussed in the consensus session.
Figure 4A
Figure 4A
Scoring and results of the assessment of risk factors identified in the literature associated with infection progression after CRGNB rectal colonization in adult population. Scores are represented according to the percentage of responses on the 1- I agree, 2-moderately agree and 3- do not agree. Result column shows if the risk factor was included as relevant, excluded, or discussed in the consensus session.
Figure 4B
Figure 4B
Scoring and results of the assessment of risk factors associated with infection progression after CRGNB rectal colonization in adult population according to expert‘s opinion. Scores are represented according to the percentage of responses on the 1- I agree, 2-moderately agree and 3- do not agree. Result column shows if the risk factor was included as relevant, excluded, or discussed in the consensus session.
Figure 5
Figure 5
Results after consensus of risk factors classified according to its relevance by pathogen in pneumonia progression after CRGNB respiratory tract colonisation in ICU adult inpatients with mechanical ventilation.
Figure 6
Figure 6
Results after consensus of risk factors classified according to its relevance by pathogen in infection progression after CRGNB rectal colonisation in adult patients.
See this image and copyright information in PMC

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References

    1. Doi Y. Treatment Options for Carbapenem-resistant Gram-negative Bacterial Infections. Clin Infect Dis. 2019;69(Suppl 7):S565-S575. doi: 10.1093/cid/ciz830. - DOI - PMC - PubMed
    1. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. . Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81. doi: 10.1111/j.1469-0691.2011.03570. - DOI - PubMed
    1. Tacconelli E, Carrara E, Savoldi A, Kattula D, Burkert F. Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics. Lancet Infect Dis. 2018;18(3):318-327. doi: 10.1016/S1473-3099(17)30753-3. - DOI - PubMed
    1. Sociedad Española de Medicina Preventiva Salud Pública e Higiene . Estudio EPINE - Prevalencia de infecciones (relacionadas con la asistencia sanitaria y comunitarias) y uso de antimicrobianos en hospitales de agudos. 2021. [cited May 2022]. Available at: https://epine.es/api/documento-publico/2019%20EPINE%20Informe%20Espa%C3%....
    1. Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, et al. . Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis. 2019;19(1):56-66. doi: 10.1016/S1473-3099(18)30605-4. - DOI - PMC - PubMed

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