3 years ago

Clinical epidemiology of carbapenem-resistant Enterobacteriaceae: a systematic review and meta-analyses.

Anne F Voor In 't Holt, Margreet C Vos, Karlijn van Loon
Carbapenem-resistant Enterobacteriaceae (CRE) are major healthcare-associated pathogens and responsible for hospital outbreaks worldwide. To prevent a further increase in CRE infections and to improve infection prevention strategies, it is important to summarize the current knowledge about CRE prevention in hospital settings. This systematic review aimed to identify risk factors for CRE acquisition among hospitalized patients. In addition, we summarized environmental sources/reservoirs and the most successful infection prevention strategies related to CRE. A total of 3,983 potentially relevant articles were identified and screened. Finally, we included 162 studies in the systematic review, of which 69 studies regarding risk factors for CRE acquisition were included in random-effects meta-analysis studies. The meta-analyses regarding risk factors for CRE acquisition showed that use of medical devices (odds ratio [OR] = 5.09; 95% confidence interval [CI] = 3.38 to 7.67) generated the highest pooled estimate, followed by carbapenem use (OR = 4.71; 95% CI = 3.54 to 6.26). To control hospital outbreaks, bundled interventions are needed including the use of barrier/contact precautions for patients colonized or infected with CRE. In addition, it is necessary to optimize the therapeutic approach; an important message to infectious disease specialists to be actively and timely involved in the treatment of known infections or suspected carriers of CRE.

Publisher URL: http://doi.org/10.1128/AAC.01730-17

DOI: 10.1128/AAC.01730-17

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