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Acquisition of antimicrobial-resistant bacteria in the absence of antimicrobial exposure: A systematic review and meta-analysis

Published online by Cambridge University Press:  29 July 2019

Erika M. C. D’Agata Open the ORCID record for Erika M. C. D’Agata [Opens in a new window] ,
Sara F. Geffert ,
Rebecca McTavish ,
Florence Wilson  and
Chris Cameron
Erika M. C. D’Agata*
Affiliation:
Infectious Disease Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island
Sara F. Geffert
Affiliation:
Infectious Disease Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island
Rebecca McTavish
Affiliation:
Cornerstone Research Group, Burlington, Canada
Florence Wilson
Affiliation:
Cornerstone Research Group, Burlington, Canada
Chris Cameron
Affiliation:
Cornerstone Research Group, Burlington, Canada
*
Author for correspondence: Erika M. C. D’Agata, Email: edagata@Lifespan.org
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Abstract

Objective:

The main risk factor for acquisition of antimicrobial-resistant bacteria (ARB) is antimicrobial exposure, although acquisition can occur in their absence. The aim of this study was to quantify the proportion of patients who acquire ARB without antimicrobial exposure.

Study design:

We searched Medline, Embase, and the Cochrane library for publications between January 1, 2000, and July 24, 2017, to identify studies of ARB acquisition in endemic settings. Studies required collection of serial surveillance cultures with acquisition defined as a negative baseline culture and a subsequent positive culture for an ARB, including either multidrug-resistant gram-negative bacteria or antimicrobial-resistant enterococci. Intervention studies were excluded. For each study, the proportion of patients who acquired an ARB but were not exposed to antimicrobials during the study period was quantified.

Results:

A total of 4,233 citations were identified; 147 underwent full-text review. Of these, 10 studies met inclusion criteria; 7 studies were considered to be at low risk of bias; and 6 studies were conducted in the intensive care unit (ICU) setting. The overall summary estimate for the proportion of patients who were not exposed to antimicrobials among those who acquired an ARB was 16.6% (95% CI, 7.8%–31.8%; P < .001), ranging from 0% to 57.1%. We observed no heterogeneity in the ICU studies but high heterogeneity among the non-ICU studies.

Conclusion:

In most included studies, a subset of patients acquired an ARB but were not exposed to antimicrobials. Future studies need to address transmission dynamics of ARB acquisition in the absence of antimicrobials.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 10 , October 2019 , pp. 1128 - 1134
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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