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Review
. 2024 Aug 9;13(8):747.
doi: 10.3390/antibiotics13080747.

The Effect of Antibiotics on the Eradication of Multidrug-Resistant Organisms in Intestinal Carriers-A Systematic Review with Meta-Analysis

Maja Johanne Søndergaard Knudsen  1 , Ingrid Maria Cecilia Rubin  1 , Andreas Munk Petersen  1   2   3
Affiliations
Review

The Effect of Antibiotics on the Eradication of Multidrug-Resistant Organisms in Intestinal Carriers-A Systematic Review with Meta-Analysis

Maja Johanne Søndergaard Knudsen et al. Antibiotics (Basel). .

Abstract

Objectives: The aim of this systematic review was to investigate the effect of antibiotics on the eradication of multidrug-resistant organisms (MRO) in intestinal carriers. We defined multidrug-resistant organisms as vancomycin-resistant Enterococcus faecium (VREfm), and multidrug-resistant Gram-negative Enterobacterales. Methods: We searched the EMBASE, Cochrane Central, and PubMed databases from inception to medio November 2023. We included randomised and controlled clinical trials (RCTs), that investigated the effect of antibiotics on the eradication of multidrug-resistant organisms in intestinal carriers. Finally, we performed a meta-analysis.

Results: We included five RTCs in the systematic review. In four studies an effect of antibiotics on the eradication of MRO was shown at the end of intervention, but it was not sustained at follow-up. In the fifth study, the effect at the end of intervention was not reported, and there was no observed effect of the intervention at follow-up. We included four studies in the meta-analysis, and it suggests an effect of antibiotics on the eradication of MRO in intestinal carriers at the end of follow-up with a p-value of 0.04 (95% confidence interval 1.02-1.95). None of the studies reported a significant increase in resistance to the study drug. Gastrointestinal disorders were the most frequent non-severe adverse event.

Conclusions: The effect of antibiotics on the eradication of multidrug-resistant organisms in intestinal carriers was not statistically significant in any of the five included studies; however, we found a significant effect in the pooled meta-analysis. As the confidence interval is large, we cannot determine the clinical importance of this finding, and it should be further investigated.

Keywords: CPE; ESBL; VREfm; antibiotics; decolonisation; eradication.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
An overview of the selected articles. The figure is adapted from the PRISMA statement. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71.
Figure 2
Figure 2
The forest plot from the meta-analysis [16,17,18,19].
See this image and copyright information in PMC

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