scholarly journals Acquisition of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae (ESBL-PE) Carriage after Exposure to Systemic Antimicrobials During Travel: Systematic Review and Meta-Analysis

2019 ◽  
Author(s):  
Terence Wuerz ◽  
Sameer S. Kassim ◽  
Katherine E. Atkins
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum

scholarly journals Epidemiology of Extended-Spectrum Beta-Lactamase and Carbapenemase-Producing Enterobacterales in the Greater Mekong Subregion: A Systematic-Review and Meta-Analysis of Risk Factors Associated With Extended-Spectrum Beta-Lactamase and Carbapenemase Isolation

2021 ◽  
Vol 12 ◽  
Author(s):  
Shweta R. Singh ◽  
Alvin Kuo Jing Teo ◽  
Kiesha Prem ◽  
Rick Twee-Hee Ong ◽  
Elizabeth A. Ashley ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Meta Analysis ◽  
Beta Lactamase ◽  
Clinical Specimens ◽  
Extended Spectrum Beta Lactamase ◽  
Factors Associated ◽  
Extended Spectrum ◽  
Log Linear ◽  
Greater Mekong Subregion

Background: Despite the rapid spread of extended-spectrum beta-lactamase (ESBL) producing-Enterobacterales (ESBL-E) and carbapenemase-producing Enterobacterales (CPE), little is known about the extent of their prevalence in the Greater Mekong Subregion (GMS). In this systematic review, we aimed to determine the epidemiology of ESBL-E and CPE in clinically significant Enterobacterales: Escherichia coli and Klebsiella pneumoniae from the GMS (comprising of Cambodia, Laos, Myanmar, Thailand, Vietnam and Yunnan province and Guangxi Zhuang region of China).Methods: Following a list of search terms adapted to subject headings, we systematically searched databases: Medline, EMBASE, Scopus and Web of Science for articles published on and before October 20th, 2020. The search string consisted of the bacterial names, methods involved in detecting drug-resistance phenotype and genotype, GMS countries, and ESBL and carbapenemase detection as the outcomes. Meta-analyses of the association between the isolation of ESBL from human clinical and non-clinical specimens were performed using the “METAN” function in STATA 14.Results: One hundred and thirty-nine studies were included from a total of 1,513 identified studies. Despite the heterogeneity in study methods, analyzing the prevalence proportions on log-linear model scale for ESBL producing-E. coli showed a trend that increased by 13.2% (95%CI: 6.1–20.2) in clinical blood specimens, 8.1% (95%CI: 1.7–14.4) in all clinical specimens and 17.7% (95%CI: 4.9–30.4) increase in carriage specimens. Under the log-linear model assumption, no significant trend over time was found for ESBL producing K. pneumoniae and ESBL-E specimens. CPE was reported in clinical studies and carriage studies past 2010, however a trend could not be determined because of the small dataset. Twelve studies were included in the meta-analysis of risk factors associated with isolation of ESBL. Recent antibiotic exposure was the most studied variable and showed a significant positive association with ESBL-E isolation (pooled OR: 2.9, 95%CI: 2.3–3.8) followed by chronic kidney disease (pooled OR: 4.7, 95%CI: 1.8–11.9), and other co-morbidities (pooled OR: 1.6, 95%CI: 1.2–2.9).Conclusion: Data from GMS is heterogeneous with significant data-gaps, especially in community settings from Laos, Myanmar, Cambodia and Yunnan and Guangxi provinces of China. Collaborative work standardizing the methodology of studies will aid in better monitoring, surveillance and evaluation of interventions across the GMS.

scholarly journals Acquisition of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) carriage after exposure to systemic antimicrobials during travel: systematic review and meta-analysis

2019 ◽  
Author(s):  
Terence C. Wuerz ◽  
Sameer S. Kassim ◽  
Katherine E. Atkins
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Odds Ratio ◽  
Meta Analysis ◽  
International Travel ◽  
Health Concern ◽  
Antimicrobial Use ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum

ABSTRACTBackgroundInternational travel is an important risk factor for colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). Antimicrobial use during travel likely amplifies this risk, yet to what extent, and whether it varies by antimicrobial class, has not been established.MethodsWe conducted a systematic review that included prospective cohorts reporting both receipt of systemic antimicrobials and acquired ESBL-PE isolated from stool or rectum during international travel. We performed a random effects meta-analysis to estimate odds of acquiring ESBL-PE due to antimicrobials during travel, overall and by antimicrobial class.ResultsFifteen studies were included. The study population was mainly female travellers from high income countries recruited primarily from travel clinics. Participants travelled most frequently to Asia and Africa with 10% reporting antimicrobial use during travel. The combined odds ratio (OR) for ESBL-PE acquisition during travel was 2.37 for antimicrobial use overall (95% confidence interval [CI], 1.69 to 3.33), but there was substantial heterogeneity between studies. Fluoroquinolones were the antibiotic class associated with the highest combined OR of ESBL-PE acquisition, compared to no antimicrobial use (OR 4.68, 95% CI, 2.34 to 9.37).ConclusionsThe risk of ESBL-PE colonization during travel is increased substantially with exposure to antimicrobials, especially fluoroquinolones. While a small proportion of colonized individuals will develop a resistant infection, there remains the potential for onward spread among returning travellers. Public health efforts to decrease inappropriate antimicrobial usage during travel are warranted.Research in contextEvidence before this studyAntimicrobial resistance (AMR) among bacteria that commonly cause human infection is of increasing public health concern. International travel has recently been associated with colonization with Extended-Spectrum Beta-Lactamase Producing-Enterobacteriaceae (ESBL-PE), increasing the spread of drug resistance among these important pathogens. We searched Pubmed, Embase, MEDLINE, Web of Science, SCOPUS, and the Cochrane Library for prospective cohort studies published between January 2000 and June 2018, reporting on acquisition of ESBL-PE among travellers, which reported on antimicrobial use during travel. 15 studies were included, which were at moderate risk of bias. The pooled odds ratio for acquisition of ESBL-PE during travel was 2.37 among antimicrobial users, compared to non-users (95% CI, 1.69 to 3.33). The magnitude of this association was stronger among travellers reporting fluoroquinolone use (OR 4.68, 95% CI 2.34 to 9.37).Added value of this studyThis is the first study to quantify the association between antimicrobial use during travel, overall and by specific antimicrobial class, with ESBL-PE acquisition across broad populations of travellers and destination countries.Implications of all the available evidenceFurther study into the mechanisms by which antimicrobials, such as fluoroquinolones, contribute to AMR may identify protective measures. Meanwhile, antimicrobial use during travel for prevention or treatment of mild-to-moderate traveller’s diarrhea should not be recommended routinely. Where indicated, alternatives to fluoroquinolone antimicrobials should be considered.

scholarly journals Prevalence of extended-spectrum beta-lactamase producing bacteria from animal origin: A systematic review and meta-analysis report from India

PLoS ONE ◽  
2019 ◽  
Vol 14 (9) ◽  
pp. e0221771 ◽  
Author(s):  
Suresh P. Kuralayanapalya ◽  
Sharanagouda S. Patil ◽  
Sudhakar Hamsapriya ◽  
Rajamani Shinduja ◽  
Parimal Roy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Animal Origin ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum
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