Bacterial Resistance in Hospital-Acquired Infections Acquired in the Intensive Care Unit: A Systematic Review.

Walter Martinez Loaiza, Anny Katheryne Rivera Ruiz, Cristian Camilo Ospina Patiño, Mónica Chavez Vivas
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Abstract

Purpose: In this review we present the status of the prevalence of bacteria resistant to antibiotics and the main antibiotic resistance genes that are reported in infections acquired in intensive care units (ICU) around the world.

Methods: A systematic review based on the PRISMA guide was carried out, from the Science Direct, Redalyc, Scopus, Hinari, Scielo, Dialnet, PLOS, ProQuest, Taylor, Lilacs and PubMed/Medline databases. Inclusion criteria of this review were original research study published in a scientific journal in a 10-year time span from 1 January 2017 and 30 April 2022.

Results: A total of 1686 studies were identified, but only 114 studies were considered eligible for inclusion. Klebsiella pneumoniae and Escherichia coli resistant to carbapenems and producers of extended-spectrum β-lactamases (ESBL) are the most frequently isolated pathogens in ICUs in Asia, Africa and Latin America. The blaOXA and blaCTX were antibiotic resistance genes (ARG) most commonly reported in different geographic regions (in 30 and 28 studies, respectively). Moreover, multidrug-resistant (MDR) strains were reported in higher frequency in hospital-acquired infections. Reports of MDR strains vary between continents, with the majority of publications being in Asia and between countries, with Egypt and Iran being highlighted. There is a predominance of few bacterial clones with MDR phenotype, for example, clonal complex 5 Methicillin-Resistant Staphylococcus aureus (CC5-MRSA) circulates frequently in hospitals in the United States, clone ST23-K. pneumoniae is reported in India and Iran, and clone ST260 carbapenemase-producing P. aeruginosa in the United States and Estonia.

Conclusion: Our systematic review reveals that ESBL- and carbapenemase-producing K. pneumoniae and E. coli are the most problematic bacteria that are reported, mainly in tertiary hospitals in Asia, Africa, and Latin America. We have also found propagation of dominant clones with a high degree of MDR, becoming a problem due to its high capacity to cause morbidity, mortality and additional hospital costs.

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重症监护病房获得性医院获得性感染中的细菌耐药性:系统综述。
目的:在这篇综述中,我们介绍了抗生素耐药菌的流行状况和主要的抗生素耐药基因在重症监护病房(ICU)获得性感染的报道。方法:基于PRISMA指南,对Science Direct、Redalyc、Scopus、Hinari、Scielo、Dialnet、PLOS、ProQuest、Taylor、Lilacs和PubMed/Medline数据库进行系统评价。本综述的纳入标准是发表在科学期刊上的原创研究,时间跨度为2017年1月1日至2022年4月30日。结果:共纳入1686项研究,但只有114项研究符合纳入条件。肺炎克雷伯菌和对碳青霉烯类耐药的大肠埃希菌以及广谱β-内酰胺酶(ESBL)的产生者是亚洲、非洲和拉丁美洲icu中最常见的分离病原体。blaOXA和blaCTX是抗生素耐药基因(ARG),在不同地理区域最常见(分别在30项和28项研究中)。此外,据报道,多药耐药(MDR)菌株在医院获得性感染中的发病率更高。关于耐多药菌株的报告在各大洲之间各不相同,大多数出版物在亚洲和国家之间,埃及和伊朗是重点。少数具有耐多药表型的细菌克隆占优势,如克隆复合体5耐甲氧西林金黄色葡萄球菌(CC5-MRSA)在美国医院中频繁流行,克隆ST23-K。印度和伊朗报道了产碳青霉烯酶的ST260克隆铜绿假单胞菌,美国和爱沙尼亚报道了产碳青霉烯酶的铜绿假单胞菌。结论:我们的系统综述显示,产ESBL和产碳青霉烯酶的肺炎克雷伯菌和大肠杆菌是报告的问题最多的细菌,主要发生在亚洲、非洲和拉丁美洲的三级医院。我们还发现,具有高度耐多药耐药性的优势克隆的繁殖成为一个问题,因为它很可能导致发病率、死亡率和额外的医院费用。
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来源期刊
Acta medica (Hradec Kralove)
Acta medica (Hradec Kralove) Medicine-Medicine (all)
CiteScore
1.10
自引率
0.00%
发文量
8
审稿时长
20 weeks
期刊介绍: Acta Medica (Hradec Králové) is a multidisciplinary medical journal published by the Faculty of Medicine in Hradec Králové - Karolinum Press, the publishing house of Charles University. The journal is peer-reviewed and published quarterly in both paper and electronic form. The language of Acta Medica is English. Offerings include review articles, original articles, brief communications, case reports, announcements and notices. The journal was founded in 1958 under the title "A Collection of Scientific Works of the Charles University Faculty of Medicine in Hradec Kralove."
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