Carbapenem Resistance, Initial Antibiotic Therapy, and Mortality inKlebsiella pneumoniaeBacteremia: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 38 (11) ◽  
pp. 1319-1328 ◽  
Author(s):  
Philipp P. Kohler ◽  
Cheryl Volling ◽  
Karen Green ◽  
Elizabeth M. Uleryk ◽  
Prakesh S. Shah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antibiotic Therapy ◽  
Meta Analysis ◽  
Carbapenem Resistance ◽  
Carbapenem Resistant ◽  
Initial Antibiotic Therapy ◽  
Meta Regression ◽  
The Difference ◽  
Meta Regression Analysis ◽  
The Impact

BACKGROUNDMortality associated with infections caused by carbapenem-resistantEnterobacteriaceae(CRE) is higher than mortality due to carbapenem-sensitive pathogens.OBJECTIVETo examine the association between mortality from bacteremia caused by carbapenem-resistant (CRKP) and carbapenem-sensitiveKlebsiella pneumoniae(CSKP) and to assess the impact of appropriate initial antibiotic therapy (IAT) on mortality.DESIGNSystematic review and meta-analysisMETHODSWe searched MEDLINE, EMBASE, CINAHL, and Wiley Cochrane databases through August 31, 2016, for observational studies reporting mortality among adult patients with CRKP and CSKP bacteremia. Search terms were related toKlebsiella, carbapenem-resistance, and infection. Studies including fewer than 10 patients per group were excluded. A random-effects model and meta-regression were used to assess the relationship between carbapenem-resistance, appropriateness of IAT, and mortality.RESULTSMortality was higher in patients who had CRKP bacteremia than in patients with CSKP bacteremia (15 studies; 1,019 CRKP and 1,148 CSKP patients; unadjusted odds ratio [OR], 2.2; 95% confidence interval [CI], 1.8–2.6; I2=0). Mortality was lower in patients with appropriate IAT than in those without appropriate IAT (7 studies; 658 patients; unadjusted OR, 0.5; 95% CI, 0.3–0.8; I2=36%). CRKP patients (11 studies; 1,326 patients; 8-year period) were consistently less likely to receive appropriate IAT (unadjusted OR, 0.5; 95% CI, 0.3–0.7; I2=43%). Our meta-regression analysis identified a significant association between the difference in appropriate IAT and mortality (OR per 10% difference in IAT, 1.3; 95% CI, 1.0–1.6).CONCLUSIONSAppropriateness of IAT is an important contributor to the observed difference in mortality between patients with CRKP bacteremia and patients with CSKP bacteremia.Infect Control Hosp Epidemiol2017;38:1319–1328

scholarly journals Molecular Investigation of miRNA Biomarkers as Chemoresistance Regulators in Melanoma: A Protocol for Systematic Review and Meta-Analysis

Genes ◽  
2022 ◽  
Vol 13 (1) ◽  
pp. 115
Author(s):  
Peter Shaw ◽  
Greg Raymond ◽  
Katherine S. Tzou ◽  
Siddhartha Baxi ◽  
Ravishankar Ram Mani ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Bibliographic Databases ◽  
Analysis Model ◽  
Pairwise Correlation ◽  
Meta Regression Analysis ◽  
Trim And Fill ◽  
The Impact

Introduction: Melanoma is a global disease that is predominant in Western countries. However, reliable data resources and comprehensive studies on the theragnostic efficiency of miRNAs in melanoma are scarce. Hence, a decisive study or comprehensive review is required to collate the evidence for profiling miRNAs as a theragnostic marker. This protocol details a comprehensive systematic review and meta-analysis on the impact of miRNAs on chemoresistance and their association with theragnosis in melanoma. Methods and analysis: The articles will be retrieved from online bibliographic databases, including Cochrane Review, EMBASE, MEDLINE, PubMed, Scopus, Science Direct, and Web of Science, with different permutations of ‘keywords’. To obtain full-text papers of relevant research, a stated search method will be used, along with selection criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Protocols 2015 (PRISMA-P) standards were used to create this study protocol. The hazard ratio (HR) with a 95% confidence interval will be analyzed using Comprehensive Meta-Analysis (CMA) software 3.0. (CI). The pooled effect size will be calculated using a random or fixed-effects meta-analysis model. Cochran’s Q test and the I2 statistic will be used to determine heterogeneity. Egger’s bias indicator test, Orwin’s and the classic fail-safe N tests, the Begg and Mazumdar rank collection test, and Duval and Tweedie’s trim and fill calculation will all be used to determine publication bias. The overall standard deviation will be evaluated using Z-statistics. Subgroup analyses will be performed according to the melanoma participants’ clinicopathological and biological characteristics and methodological factors if sufficient studies and retrieved data are identified and available. The source of heterogeneity will be assessed using a meta-regression analysis. A pairwise matrix could be developed using either a pairwise correlation or expression associations of miRNA with patients’ survival for the same studies.

scholarly journals Long-term manifestations and modifiers of prevalence estimates of the post-COVID-19 syndrome: A systematic review and meta-analysis.

2021 ◽  
Author(s):  
Daniel De-la-Rosa-Martínez ◽  
Marco Antonio Delaye-Martínez ◽  
Omar Yaxmehen Bello-Chavolla ◽  
Alejandro Sicilia-Andrade ◽  
Isaac David Juárez-Cruz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Regression Analysis ◽  
Meta Analysis ◽  
Population Characteristics ◽  
Published Data ◽  
System Disease ◽  
Prevalence Estimates ◽  
Meta Regression ◽  
Meta Regression Analysis

Background: Post-acute COVID-19 syndrome (PACS) is a multi-system disease comprising persistent symptomatology after the acute phase of infection. Long-term PACS effects significantly impact patient outcomes, but their incidence remains uncharacterized due to high heterogeneity between studies. Therefore, we aimed to summarize published data on PACS, characterizing the clinical presentation, prevalence, and modifiers of prevalence estimates. Method: In this systematic review and meta-analysis, we research MEDLINE for original studies published from January 1st, 2020, to January 31st, 2021, that reported proportions of PACS manifestations. Studies were eligible for inclusion if they included patients aged ≥18 years with confirmed COVID-19 by RT-PCR or antigen testing and a minimum follow-up of 21 days. The prevalence of individual manifestations across studies was pooled using random-effects meta-analysis. For evaluating determinants of heterogeneity, meta-regression analysis was performed. This study was registered in PROSPERO (CRD42019125025). Results: After screening 1,235 studies, we included 29 reports for analysis. Twenty-seven meta-analyses were performed, and 61 long-term manifestations were described. The pooled prevalence of PACS was 56% (95%CI 45-66%), with the most common manifestations being diminished health status, fatigue, asthenia, dyspnea, myalgias, hyposmia and dysgeusia. Most of the included studies presented high heterogeneity. After conducting the meta-regression analysis, we identified that age, gender, number of comorbidities, and reported symptoms significantly modify the prevalence estimation of PACS long-term manifestations. Conclusion: PACS is inconsistently reported between studies, and population characteristics influence the prevalence estimates due to high heterogeneity. A systematized approach for the study of PACS is needed to characterize its impact adequately.

scholarly journals Optimal duration of prone positioning in patients with acute respiratory distress syndrome: a protocol for a systematic review and meta-regression analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e021408 ◽  
Author(s):  
Tetsuro Kamo ◽  
Yoshitaka Aoki ◽  
Tatsuma Fukuda ◽  
Kiyoyasu Kurahashi ◽  
Hideto Yasuda ◽  
...  
Keyword(s):  
Systematic Review ◽  
Distress Syndrome ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Prone Positioning ◽  
Short Term ◽  
Optimal Duration ◽  
Short Term Mortality ◽  
Meta Regression ◽  
Meta Regression Analysis

IntroductionSeveral systematic reviews and meta-analyses have demonstrated that prolonged (≥16 hours) prone positioning can reduce the mortality associated with acute respiratory distress syndrome (ARDS). However, the effectiveness and optimal duration of prone positioning was not fully evaluated. To fill these gaps, we will first investigate the effectiveness of prone positioning compared with the conventional management of patients with ARDS, regarding outcomes using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Second, if statistical heterogeneity in effectiveness with regard to short-term mortality (intensive care unit death or ≤30-day mortality) is shown, we will conduct a meta-regression analysis to explore the association between duration and effectiveness, and determine the optimal duration of prone positioning.Method and analysisRelevant studies are collected using PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials and the WHO International Clinical Trials Platform Search Portal. Randomised controlled trials comparing prone and supine positioning in adults with ARDS will be included in the meta-analysis. Two independent investigators will screen trials obtained by search eligibility and extract data from selected studies to standardised data recording forms. For each selected trial, the risk of bias and quality of evidence will be evaluated using the GRADE system. Meta-regression analyses will be performed to identify the most important factors associated with short-term mortality, and subgroup analysis will be used to analyse the following: duration of mechanical ventilation in the prone position per day, patient severity, tidal volume and cause of ARDS. If heterogeneity or inconsistency among the studies is detected, subgroup analysis will be conducted on factors that may cause heterogeneity.Ethics and disseminationThis study requires no ethical approval. The results obtained from this systematic review and meta-analysis will be disseminated through international conference presentations and publication in a peer-reviewed journal.PROSPERO registration numberCRD42017078340.

scholarly journals In vivo studies on antibiotic combination for the treatment of carbapenem-resistant Gram-negative bacteria: a systematic review and meta-analysis protocol

2020 ◽  
Vol 4 (1) ◽  
pp. e100055
Author(s):  
Elda Righi ◽  
Luigia Scudeller ◽  
Margherita Chiamenti ◽  
Kamilia Abdelraouf ◽  
Thomas Lodise ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
In Vivo Models ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
The Impact ◽  
Antibiotic Combination

ObjectiveThere is poor evidence to determine the superiority of combination regimens versus monotherapy against infections due to carbapenem-resistant (CR) Gram-negative bacteria. In vivo models can simulate the pathophysiology of infections in humans and assess antibiotic efficacy. We aim to investigate in vivo effects of antibiotic combination on mortality and disease burden for infections due to CR Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacteriaceae and provide an unbiased overview of existing knowledge. The results of the study can help prioritising future research on the most promising therapies against CR bacteria.Methods and analysisThis protocol was formulated using the Systematic Review Protocol for Animal Intervention Studies (SYRCLE) Checklist. Publications will be collected from PubMed, Scopus, Embase and Web of Science. Quality checklists adapted by Collaborative Approach to Meta-Analysis and Review of Animal Data from Experimental Studies and SYRCLE’s risk of bias tool will be used. If the meta-analysis seems feasible, the ES and the 95% CI will be analysed. The heterogeneity between studies will be assessed by I2 test. Subgroup meta-analysis will be performed when possible to assess the impact of the studies on efficacy of the treatments. Funnel plotting will be used to evaluate the risk of publication bias.DisseminationThis systematic review and meta-analysis is part of a wider research collaboration project, the COmbination tHErapy to treat sepsis due to carbapenem-Resistant bacteria in adult and paediatric population: EvideNCE and common practice (COHERENCE) study that includes also the analyses of in vitro and human studies. Data will be presented at international conferences and the results will be published in peer-reviewed journals.PROSPERO registration numberCRD42019128104(available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019128104).

scholarly journals Mortality Associated With Acute Respiratory Distress Syndrome 2009-2019: A Systematic Review and Meta-regression 

2020 ◽  
Author(s):  
Divyajot Sadana ◽  
Simrat Kaur ◽  
Kesavan Sankaramangalam ◽  
Kinjal Banerjee ◽  
Matthew Siuba ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
2009 H1n1 ◽  
Meta Regression ◽  
Meta Regression Analysis

Abstract Background: Acute respiratory distress syndrome (ARDS) is a common occurrence in an intensive care unit. The reported mortality in studies evaluating acute respiratory distress syndrome is highly variable. The adherence to ventilatory specific and adjunctive therapies is also highly variable. We investigated the mortality of ARDS since the 2009 H1N1 pandemic and examined the adherence to ventilatory specific and adjunctive therapies.Methods: We performed a systematic search in MEDLINE and EMBASE using a highly sensitive criterion from January 2009 to May 2019. We then ran a proportional meta-analysis for mortality and a meta-regression analysis using certain variables to address heterogeneity. Results: We screened 5361 citations, of which 85 fully met inclusion criteria. The weighted pooled mortality of all 85 studies published from 2009 to 2019 was 38% (95% CI 35,40). Mortality was higher in observational studies [40% (95% CI 37, 42)] compared to RCTs [35% (95% CI 30,39)], (p=0.04) Significant variability exists in literature of reported tidal volumes, positive end expiratory pressures, plateau pressures, and use adjunctive therapies. The tidal volumes in our systematic review ranged from 5.8 to 8.9 ml/kg with a mean of 7.2 ml/kg. PEEP ranged from 4.6 to 16.1 cm H2O at the time of enrollment with a mean of 10.2 cm H2O. Reported plateau pressures ranged from 21.0 to 35.1 cm H2O, with a mean of 25.6 cm H2O. Higher reported initial PaO2/FiO2 ratios were associated with decreased mortality. A trend towards decreased mortality was seen with lower reported tidal volumes in the included studies.Conclusions: Over the last decade, the mortality in ARDS has marginally improved and there exists significant heterogeneity in the utilization of low tidal volume strategies, application of PEEP and the adoption of adjunctive therapies in the management of these patients in published literature.

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