นโยบายงานวิจัย /จรรยาบรรณนักวิจัย /ระดับคุณภาพบทความวิจัยตีพิมพ์ /ระดับคุณภาพผลงานวิชาการ /แหล่งทุน /ดาวน์โหลด /ฐานข้อมูลวิจัย /วิเคราะห์-สังเคราะห์งานวิจัย /ลิขสิทธิ์ /ข่าว


A Systematic Review of the Burden of Multidrug-Resistant Healthcare-Associated Infections Among Intensive Care Unit Patients in Southeast Asia: The Rise of Multidrug-Resistant Acinetobacter baumannii


Author

-

Teerawattanapong N1, Panich P2, Kulpokin D2, Na Ranong S3, Kongpakwattana K4, Saksinanon A4, Goh BH4, Lee LH4, Apisarnthanarak A5, Chaiyakunapruk N4

Affiliations
1 Division of Pharmacy Practice, Faculty of Pharmaceutical Sciences,Ubon Ratchathani University,Ubon Ratchathani,Thailand.
2 Faculty of Pharmacy,Silpakorn University,Nakorn Pathom,Thailand.
3 Faculty of Pharmacy,Prince of Songkla University,Songkla,Thailand.
4 School of Pharmacy,Monash University Malaysia,Selangor,Malaysia.
5 Division of Infectious Diseases,Thammasat University Hospital,Pratumthani,Thailand.


Journal

- Infect Control Hosp Epidemiol.

Volume

- 0

Year

- 2018

Publication type

- Research article (Inter)

Page list

- 1-9.

Abstract

   

OBJECTIVE To summarize the clinical burden (cumulative incidence, prevalence, case fatality rate and length of stay) and economic burden (healthcare cost) of healthcare-associated infections (HAIs) due to multidrug-resistant organisms (MDROs) among patients in intensive care units (ICUs) in Southeast Asia.

DESIGN Systematic review.

METHODS We conducted a comprehensive literature search in PubMed, EMBASE, CINAHL, EconLit, and the Cochrane Library databases from their inception through September 30, 2016. Clinical and economic burdens and study quality were assessed for each included study.

RESULTS In total, 41 studies met our inclusion criteria; together, 22,876 ICU patients from 7 Southeast Asian countries were included. The cumulative incidence of HAI caused by A. baumannii (AB) in Southeast Asia is substantially higher than has been reported in other regions, especially carbapenem-resistant AB (CRAB; 64.91%) and multidrug-resistant AB (MDR-AB) (58.51%). Evidence of a dose-response relationship between different degrees of drug resistance and excess mortality due to AB infections was observed. Adjusted odds ratios were 1.23 (95% confidence interval [CI], 0.51-3.00) for MDR-AB, 1.72 (95% CI, 0.77-3.80) for extensively drug-resistant AB (XDR-AB), and 1.82 (95% CI, 0.55-6.00) for pandrug-resistant AB (PDR-AB). There is, however, a paucity of published data on additional length of stay and costs attributable to MDROs.

CONCLUSIONS This review highlights the challenges in addressing MDROs in Southeast Asia, where HAIs caused by MDR gram-negative bacteria are abundant and have a strong impact on society. With our findings, we hope to draw the attention of clinicians and policy makers to the problem of antibiotic resistance and to issue a call for action in the management of MDROs.


Keywords

   

Multidrug-resistant organism, Healthcare-associated infection, Intensive care unit, Acinetobacter baumannii, Southeast Asia