Clinical Epidemiology Of CRE Bacteremia In Hospitalized Patients Worldwide

Background During recent years,outbreaks due to Carbapenem-Resistant Enterobacteriaceae(CRE)have been reported in many countries around the world.The morbidity and mortality of Carbapenem-Resistant Enterobacteriaceae blood stream infections have increased year by year,becoming a global public health threat in the past decade.Objectives This study was aimed to systematically review published data to evaluate the clinical epidemiology,to explore the risk factors for both the acquisition and mortality of CRE bacteremia among hospitalized patients worldwide.Furthermore,we are going to figure out the essential components of effective infection control in preventing or ending hospital CRE bacteremia outbreaks for clinicians.Methods This meta-analysis was conducted in accordance with the guidelines of PRISMA.The reports concerning the CRE bacteremia in hospitalized adult patients among the published literature before May 2019 were identified by a systematic search of Pubmed,EMBASE and Cochrane.Summary odds ratios(OR)were calculated using the random effects models,and study quality was assessed using a modified Newcastle-Ottawa scale.For continuous variables with normal distribution,it is expressed as mean ± standard deviation.Considering the existence of heterogeneity,the Q-test with a significance level set to P <0.10 was used.Heterogeneity was quantified by I2 statistics.If I2> 50%,sensitivity and subgroup analyses are performed to explain the source of heterogeneity.For risk factors that included more than five studies,funnel plots were used to assess publication bias.Results Totally 573 literatures were retrieved out,and we identified 42 studies to calculate the statistically significant pooled odds ratio,among which 22 papers were asociated with describing factors for CRE-BSIs morbidity and26 papers with mortality.Urinary catheter(OR 3.87;95%CI 2.63-5.70;I2=36%),the use of colistin(OR 2.81;95%CI 1.79-4.43;I2= 28%)and cephalosporins(OR 2.15;95%CI 1.47-3.13;I2 = 30%)generated the highest pooled estimate for CRE-BSIs morbidity.Underlying diseases or conditions(such as malignancy,chronic renal disease,hemodialysis,and septic shock)led to an unfortunate ending for patients with CRE-BSI.Appropriate empirical therapy contributed to reduce mortality for CRE-BSIs,and the use of ceftazidime-avibactam,lower Pitt bacteremia score or APACHE2 score were also relevant to decreased mortality.Conclusions The worldwide morbidity and mortality for CRE-BSIs are high.We should standardize medical practices,optimize the therapeutic approach,timely monitor relevant indicators to control hospital outbreaks.