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- Title
Natural history and decolonization strategies for ESBL/carbapenem-resistant Enterobacteriaceae carriage: systematic review and meta-analysis.
- Authors
Bar-Yoseph, Haggai; Hussein, Khetam; Braun, Eyal; Paul, Mical
- Abstract
<bold>Background: </bold>ESBL-producing Enterobacteriaceae and carbapenem-resistant Enterobacteriaceae (CRE) are rapidly spreading worldwide. Their natural reservoir is intestinal.<bold>Methods: </bold>We carried out a systematic review and meta-analysis to estimate CRE and ESBL carriage duration and to evaluate the effect of decolonization therapy. We included cohort and comparative studies examining the natural history of CRE/ESBL colonization, examining rates of carriage following decolonization or comparing decolonization and no decolonization conducted in the healthcare setting or in the community. A comprehensive search was conducted until November 2015. We compiled carriage rates at 1, 3, 6 and 12 months with and without decolonization therapy and assessed the effect of decolonization.<bold>Results: </bold>Thirty-seven studies fulfilled inclusion criteria. In healthcare settings, pooled ESBL/CRE colonization rates decreased without intervention from 76.7% (95% CI = 69.3%-82.8%) at 1 month to 35.2% (95% CI = 28.2%-42.9%) at 12 months of follow-up. Following decolonization, the rate was 37.1% (95% CI = 27.5%-47.7%) at end of therapy and 57.9% (95% CI = 43.1%-71.4%) at 1 month. In two randomized trials, carriage was significantly reduced at end of therapy (risk ratio = 0.42, 95% CI = 0.25-0.65), but the effect was not significant after 1 month (risk ratio = 0.72, 95% CI = 0.48-1.05), with no longer follow-up. Heterogeneity was explained by surveillance methodology, with no differences observed between ESBLs and CREs. Among community dwellers, ESBL colonization decreased from 52.3% (95% CI = 29.5%-74.2%) at 1 month to 19.2% (95% CI = 9.7%-34.4%) at 6 months.<bold>Conclusions: </bold>A significant proportion of ESBL and CRE carriers remain colonized up to 1 year in the healthcare setting. While short-term decolonization therapy reduces carriage during therapy, its longer-term effects are unclear.
- Subjects
ENTEROBACTERIACEAE; CARBAPENEMS; MEDICAL care; META-analysis; COMPARATIVE studies; ANTIBIOTICS; GUT microbiome; CARRIER state (Communicable diseases); DRUG resistance in microorganisms; HYDROLASES; TIME; SYSTEMATIC reviews; ENTEROBACTERIACEAE diseases; PHARMACODYNAMICS; THERAPEUTICS
- Publication
Journal of Antimicrobial Chemotherapy (JAC), 2016, Vol 71, Issue 10, p2729
- ISSN
0305-7453
- Publication type
journal article
- DOI
10.1093/jac/dkw221