Systematic Review and Meta-analysis of Deaths Attributable to Antimicrobial Resistance, Latin America

Abstract

Antimicrobial resistance is a pressing global health concern, leading to 4.95 million deaths in 2019. We conducted a systematic review and meta-analysis to assess the lethality attributed to infections caused by multidrug-resistant organisms (MDROs) in Latin America and the Caribbean. A comprehensive search of major databases retrieved relevant studies from 2000-2022. We included 54 observational studies, primarily from Brazil, Argentina, and Colombia. The most commonly studied organism was methicillin-resistant Staphylococcus aureus. The overall unadjusted case fatality rate related to MDROs was 45.0%; higher adjusted lethality was observed in persons infected with MDROs than in those infected with other pathogens (adjusted odds ratio 1.93, 95% CI 1.58-2.37). A higher lethality rate was seen in patients who did not receive appropriate empirical treatment (odds ratio 2.27, 95% CI 1.44-3.56). These findings underscore the increased lethality associated with antimicrobial resistance in Latin America and the Caribbean.

Keywords: Argentina; Brazil; Caribbean region; Colombia; Latin America; antimicrobial resistance; bacteria; lethality; methicillin-resistant Staphylococcus aureus; mortality.

Figure 1

Flowchart demonstrating identification process of studies for systematic review and meta-analysis of deaths attributable to antimicrobial resistance, Latin America. CINAHL, Cumulative Index to Nursing and Allied Health Literature; LILACS, Latin American and Caribbean Health Sciences Literature).

Figure 2

Association between antimicrobial resistance and lethality by the type of resistance in systematic review and meta-analysis of deaths attributable to antimicrobial resistance, Latin America. Adjusted measures are shown as adjusted odds ratio (A), adjusted hazard ratio (B), and adjusted risk ratio (C). Death-R indicates death in the resistant group; Death-S indicates death in the susceptible group. Error bars indicate 95% CIs. CR-AB, carbapenem-resistant Acinetobacter baumannii; CRE, carbapenem-resistant Enterobacterales; CR-GNB, carbapenem-resistant gram-negative bacteria (including CRE, CR-PA, CR-AB); CR-PA, carbapenem-resistant Pseudomonas aeruginosa; CRO, carbapenem-resistant organisms; ESBL-E, extended-spectrum β-lactamase–producing Enterobacterales; HR, hazard ratio; LAC, Latin American and Caribbean; MDR-GNB, multidrug-resistant gram-negative bacilli (including ESBL-E, CRE, CR-PA, CR-AB); MDRO, multidrug-resistant organisms (including MRSA, vancomycin-resistant Enterococcus, ESLB-E, CRE, CR-PA, CR-AB); MRSA, methicillin-resistant Staphylococcus aureus; OR, odds ratio; RR, risk ratio.

Figure 3

Adjusted odds ratios between antimicrobial resistance and lethality by appropriate empirical antibiotic treatment (considering the definition of appropriate empirical treatment given by each author) in systematic review and meta-analysis of deaths attributable to antimicrobial resistance, Latin America. Death-R indicates death in the resistant group; Death-S indicates death in the susceptible group. Error bars indicate 95% CIs. CR-AB, carbapenem-resistant Acinetobacter baumannii; CRE, carbapenem-resistant Enterobacterales; CR-PA, carbapenem-resistant Pseudomonas aeruginosa; ESBL-E, extended-spectrum β-lactamase–producing Enterobacterales; MDR-GNB, multidrug-resistant gram-negative bacilli (including ESBL-E, CRE, CR-PA, CR-AB); MDRO, multidrug-resistant organisms (including MRSA, vancomycin-resistant Enterococcus, ESLB-E, CRE, CR-PA, CR-AB); MRSA, methicillin-resistant Staphylococcus aureus; NR, not reported; OR, odds ratio.

Figure 4

Pooled unadjusted OR between antimicrobial resistance and lethality by calendar recruitment period in systematic review and meta-analysis of deaths attributable to antimicrobial resistance, Latin America. Data points depict pooled lethality estimates from random effects meta-analysis models. Error bars indicate 95% CIs. OR, odds ratio.