Rate of polymyxin resistance among Acinetobacter baumannii recovered from hospitalized patients: a systematic review and meta-analysis

Lima, W. G. and Brito, J. C. M. and Cardoso, B. G. and Cardoso, V. N. and de Paiva, M. C. and de Lima, M. E. and Fernandes, S. O. A.

Eur J Clin Microbiol Infect Dis (2020) 39: 1427–1438

DOI: 10.1007/s10096-020-03876-x

Abstract

We conducted a systematic review and meta-analysis to determine the rate of polymyxin resistance among Acinetobacter baumannii isolates causing infection in hospitalized patients around the world during the period of 2010-2019. The systematic review was performed on September 1, 2019, using PubMed/MEDLINE, Scopus, and Web of Science; studies published after January 1, 2010, were selected. The data were summarized in tables, critically analyzed, and treated statistically using the RStudio® Software with Meta package and Metaprop Command. After applying exclusion factors, 41 relevant studies were selected from 969 articles identified on literature search. The overall rate of polymyxin-resistant A. baumannii (PRAB) related to hospitalized patients was estimated to be 13% (95% CI, 0.06-0.27), where a higher rate was observed in America (29%; 95% CI, 0.12-0.55), followed by Europe (13%; 95% CI, 0.02-0.52), and Asia (10%; 95% CI, 0.02-0.32). The extensive use of polymyxins on veterinary to control bacterial infection and growth promotion, as well as the resurgence in prescription and use of polymyxins in the clinics against carbapenem-resistant gram-negative bacteria, may have contributed to the increased incidence of PRAB. The findings of this meta-analysis revealed that the rate of PRAB recovered from hospitalized patients is distinctively high. Thus, action needs to be taken to develop strategies to combat the clinical incidence of PRAB-induced hospital infections.

Citation

Lima, W. G., Brito, J. C. M., Cardoso, B. G., Cardoso, V. N., de Paiva, M. C., de Lima, M. E., & Fernandes, S. O. A. (2020). Rate of polymyxin resistance among Acinetobacter baumannii recovered from hospitalized patients: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis, 39(8), 1427–1438. https://doi.org/10.1007/s10096-020-03876-x Acinetobacter baumannii, Carbapenem resistant, Colistin, Hospital infections, Polymyxin B

Keywords

• Acinetobacter baumannii
• Carbapenem resistant
• Colistin
• Hospital infections
• Polymyxin B