title: Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies.
abstract: Whether carbapenem resistance is associated with mortality in patients with Pseudomonas aeruginosa bacteremia is controversial. To address this issue, we conducted a systematic review and meta-analysis based on cohort studies. We searched PubMed and Embase databases to identify articles (up to April 2015). The DerSimonian and Laird random-effect model was used to generate a summary estimate of effect. Associations were evaluated in subgroups based on different patient characteristics and study quality criteria. Seven studies with a total of 1613 patients were finally included, of which 1 study had a prospective design, and the other 6 were retrospective. Our meta-analysis showed patients with carbapenem-resistant P. aeruginosa bacteremia were at a higher risk of death compared with those with carbapenem-susceptible P. aeruginosa bloodstream infections (pooled odds ratio (OR) from three studies reporting adjusted ORs: 3.07, 95% confidence interval (CI), 1.60-5.89; pooled OR from 4 studies only reporting crude ORs: 1.46, 95% CI, 1.10-1.94). The results were robust across a number of stratified analyses and a sensitivity analysis. We also calculated that 8%-18.4% of deaths were attributable to carbapenem resistance in four studies assessing the outcome with 30-day mortality, and these were 3% and 14.6%, respectively, in two studies using 7-day mortality or mortality during bacteremia as an outcome of interest. Carbapenem resistance had a deleterious impact on the mortality of P. aeruginosa bacteremia; however, the results should be interpreted cautiously because only three studies reporting adjusted ORs were included. More large-scale, well-designed prospective cohorts, as well as mechanistic studies, are urgently needed in the future.
authors.affiliation: Department of Laboratory, Guangdong Academy of Medicine Science & Guangdong General Hospital, Guangzhou 510080, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Laboratory, Guangdong Academy of Medicine Science & Guangdong General Hospital, Guangzhou 510080, China.
authors.forename: Xiao-Li
authors.initials: XL
authors.lastname: Chen
authors.affiliation: Department of Laboratory, Guangdong Academy of Medicine Science & Guangdong General Hospital, Guangzhou 510080, China.
authors.forename: Ai-Wei
authors.initials: AW
authors.lastname: Huang
authors.affiliation: Department of Laboratory, Guangdong Academy of Medicine Science & Guangdong General Hospital, Guangzhou 510080, China.
authors.forename: Su-Ling
authors.initials: SL
authors.lastname: Liu
authors.affiliation: Department of Laboratory, Guangdong Academy of Medicine Science & Guangdong General Hospital, Guangzhou 510080, China.
authors.forename: Wei-Jiang
authors.initials: WJ
authors.lastname: Liu
authors.affiliation: Department of Laboratory, Guangdong Academy of Medicine Science & Guangdong General Hospital, Guangzhou 510080, China.
authors.forename: Ni
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Quality Control Department, Guangdong Women and Children Hospital, Guangzhou 510010, China.
authors.forename: Xu-Zai
authors.initials: XZ
authors.lastname: Lu
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000382:microbiology* / Q000401:mortality*; D015780:Carbapenems / Q000494:pharmacology*; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests; D016017:Odds Ratio; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000382:microbiology / Q000401:mortality*; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems