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Meta-Analysis
. 2023 Dec;12(1):2217951.
doi: 10.1080/22221751.2023.2217951.

Predictors of mortality from extended-spectrum beta-lactamase-producing Enterobacteriaceae bacteremia

Hiroki Namikawa  1 , Waki Imoto  2 , Koichi Yamada  2   3 , Yoshihiro Tochino  1 , Yukihiro Kaneko  4 , Hiroshi Kakeya  2   3 , Taichi Shuto  1
Affiliations
Meta-Analysis

Predictors of mortality from extended-spectrum beta-lactamase-producing Enterobacteriaceae bacteremia

Hiroki Namikawa et al. Emerg Microbes Infect. 2023 Dec.

Abstract

ABSTRACTExtended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) bacteremia can have poor clinical outcomes. Thus, determining the predictors of mortality from ESBL-PE bacteremia is very important. The present systematic review and meta-analysis aimed to evaluate studies to determine predictors associated with ESBL-PE bacteremia mortality. We searched PubMed and Cochrane Library databases for all relevant publications from January 2000 to August 2022. The outcome measure was mortality rate. In this systematic review of 22 observational studies, 4607 patients with ESBL-PE bacteremia were evaluated, of whom 976 (21.2%) died. The meta-analysis showed that prior antimicrobial therapy (RR, 2.89; 95% CI, 1.22-6.85), neutropenia (RR, 5.58; 95% CI, 2.03-15.35), nosocomial infection (RR, 2.46; 95% CI, 1.22-4.95), rapidly fatal underlying disease (RR, 4.21; 95% CI, 2.19-8.08), respiratory tract infection (RR, 2.12; 95% CI, 1.33-3.36), Pitt bacteremia score (PBS) (per1) (RR, 1.35; 95% CI, 1.18-1.53), PBS ≥ 4 (RR, 4.02; 95% CI, 2.77-5.85), severe sepsis (RR, 11.74; 95% CI, 4.68-29.43), and severe sepsis or septic shock (RR, 4.19; 95% CI, 2.83-6.18) were found to be mortality predictors. Moreover, urinary tract infection (RR, 0.15; 95% CI, 0.04-0.57) and appropriate empirical therapy (RR, 0.39; 95% CI, 0.18-0.82) were found to be a protective factor against mortality. Patients with ESBL-PE bacteremia who have the aforementioned require prudent management for improved outcomes. This research will lead to better management and improvement of clinical outcomes of patients with bacteremia caused by ESBL-PE.

Keywords: Enterobacteriaceae; Extended-spectrum beta-lactamase; bacteremia; meta-analysis; mortality.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Flow diagram of selection process for included studies.
Figure 2.
Figure 2.
Forest plot of risk ratio for mortality of patients with (a) prior antimicrobial therapy, (b) neutropenia, (c) nosocomial infection, (d) rapidly fatal underlying disease, (e) respiratory tract infection, (f) urinary tract infection, (g) Pitt bacteremia score (per1), (h) Pitt bacteremia score ≥4, (i) severe sepsis, (j) severe sepsis or septic shock, and (k) appropriate empirical therapy for extended-spectrum beta-lactamase-producing Enterobacteriaceae bacteremia.
Figure 2.
Figure 2.
Forest plot of risk ratio for mortality of patients with (a) prior antimicrobial therapy, (b) neutropenia, (c) nosocomial infection, (d) rapidly fatal underlying disease, (e) respiratory tract infection, (f) urinary tract infection, (g) Pitt bacteremia score (per1), (h) Pitt bacteremia score ≥4, (i) severe sepsis, (j) severe sepsis or septic shock, and (k) appropriate empirical therapy for extended-spectrum beta-lactamase-producing Enterobacteriaceae bacteremia.
Figure 2.
Figure 2.
Forest plot of risk ratio for mortality of patients with (a) prior antimicrobial therapy, (b) neutropenia, (c) nosocomial infection, (d) rapidly fatal underlying disease, (e) respiratory tract infection, (f) urinary tract infection, (g) Pitt bacteremia score (per1), (h) Pitt bacteremia score ≥4, (i) severe sepsis, (j) severe sepsis or septic shock, and (k) appropriate empirical therapy for extended-spectrum beta-lactamase-producing Enterobacteriaceae bacteremia.
Figure 3.
Figure 3.
Forest plot showing the odds ratio of the mortality for carbapenems versus non-carbapenems in patients with extended-spectrum beta-lactamase-producing Enterobacteriaceae bacteremia.
See this image and copyright information in PMC

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