A review and meta-analysis finds that the risk of an antibiotic-resistant infection in patients colonized with drug-resistant gram-negative bacteria is around 14%, Dutch and German researchers reported yesterday in The Lancet Infectious Diseases.
For the study, a team led by researchers with the Amsterdam University Medical Centers reviewed studies published from 1995 to March 2022 that measured the incidence of infections with multidrug-resistant gram-negative bacteria (MDR-GNB) and vancomycin-resistant enterococci (VRE), including only studies that reported length of follow-up. Their aim was to quantify the effect of gut or urinary colonization with MDR-GNB and VRE on the subsequent risk of infection from these multidrug-resistant pathogens.
Of 301 studies reviewed, 44 (26 on MDR-GNB, 14 on VRE, and 4 on both) involving 14,049 patients from 14 countries were included, 40 of which were analyzed with meta-regression. The pooled cumulative incidence of infection was 14% (95% confidence interval [CI], 10% to 18%) at a median follow-up of 30 days for MDR-GNB and 8% (95% CI, 5% to 13%) at 30 days for VRE.
Infection incidence density (4.26 infections per 1,000 patient-days) and cumulative incidence of infection (19%; 95% CI, 15% to 25%) were highest for carbapenem-resistant Enterobacterales (CRE) at 30 days. Cumulative incidence of infection with extended-spectrum beta-lactamase–producing Enterobacterales or third-generation cephalosporin-resistant Enterobacterales was 8% (95% CI, 5% to 13%).
The study authors note the risk of infection at 30 days in patients colonized with MDR-GNB, particularly CRE, is similar to the risk of surgical-site infections after contaminated or dirty surgical procedures (18% to 25%).
"These differences imply that screening of patient populations at high risk of colonisation and subsequent adjustment of empirical antimicrobial treatment is of greater clinical relevance in the setting of MDR-GNB than of VRE," they wrote. "Additionally, this comparative analysis of infection risks can help to prioritise future research and implementation of targeted prophylactic interventions, such as decolonisation strategies, by indicating the type of multidrug-resistant bacteria and the patient population carrying the highest infection risk."