Posts filed under ‘Meta-Análisis’

Timing of preoperative antibiotic prophylaxis in 54,552 patients and the risk of surgical site infection: A systematic review and meta-analysis

Medicine July 2017 V.96 N.29 P.e6903

de Jonge, Stijn Willem MDa; Gans, Sarah L. MD, PhDa; Atema, Jasper J. MD, PhDa; Solomkin, Joseph S. MDb; Dellinger, Patchen E. MDc; Boermeester, Marja A. MD, PhDa,*

Abstract

The aim of the study was to assess the effect of timing of preoperative surgical antibiotic prophylaxis (SAP) on surgical site infection (SSI) and compare the different timing intervals.

The benefit of routine use of SAP prior to surgery has long been recognized. However, the optimal timing has not been defined. For the purpose of developing recommendations for the World Health Organization guideline for SSI prevention, a systematic review and meta-analysis of all relevant evidence was conducted.

Major medical databases were searched from 1990 to 2016. The primary outcome was SSI after preoperative-SAP comparing different timing intervals. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were extracted and pooled for each comparison with a random effects model.

Fourteen papers with 54,552 patients were included in this review. In a quantitative analysis, there was no significant difference when SAP was administered 120–60 minutes prior to incision compared to administration 60–0 minutes prior to incision. Studies investigating different timing intervals within the last 60 minutes time frame reported contradictive results. The risk of SSI almost doubled when SAP was administered after first incision (OR:1.89; 95%CI:[1.05–3.40]) and was 5 times higher when administered more than 120 minutes prior to incision (OR5.26; 95%CI:[3.29–8.39]).

Administration of antibiotic prophylaxis more than 120 minutes before incision or after incision is associated a higher risk of surgical site infections than administration less than 120 minutes before incision. Within this 120-minute time frame prior to incision, no differential effects could be identified. The broadly accepted recommendation to administer prophylaxis within a 60-minute time frame prior to incision could not be substantiated.

FULL TEXT

http://journals.lww.com/md-journal/Fulltext/2017/07210/Timing_of_preoperative_antibiotic_prophylaxis_in.1.aspx

PDF CLIC en “Article as PDF” (download)

July 22, 2017 at 10:01 am

The efficacy and safety of tigecycline for the treatment of bloodstream infections: a systematic review and meta-analysis.

Ann Clin Microbiol Antimicrob. April 5, 2017 V.16 N.1 P.24.     

Wang J1, Pan Y1, Shen J2, Xu Y1.

Author information

1 Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, 230022, Anhui, China.

2 Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, 230022, Anhui, China. shenjilu@126.com

Abstract

Patients with bloodstream infections (BSI) are associated with high mortality rates. Due to tigecycline has shown excellent in vitro activity against most pathogens, tigecycline is selected as one of the candidate drugs for the treatment of multidrug-resistant organisms infections.

The purpose of this study was to evaluate the effectiveness and safety of the use of tigecycline for the treatment of patients with BSI. The PubMed and Embase databases were systematically searched, to identify published studies, and we searched clinical trial registries to identify completed unpublished studies, the results of which were obtained through the manufacturer.

The primary outcome was mortality, and the secondary outcomes were the rate of clinical cure and microbiological success. 24 controlled studies were included in this systematic review. All-cause mortality was lower with tigecycline than with control antibiotic agents, but the difference was not significant (OR 0.85, [95% confidence interval (CI) 0.31-2.33; P = 0.745]). Clinical cure was significantly higher with tigecycline groups (OR 1.76, [95% CI 1.26-2.45; P = 0.001]).

Eradication efficiency did not differ between tigecycline and control regimens, but the sample size for these comparisons was small. Subgroup analyses showed good clinical cure result in bacteremia patients with CAP. Tigecycline monotherapy was associated with a OR of 2.73 (95% CI 1.53-4.87) for mortality compared with tigecycline combination therapy (6 studies; 250 patients), without heterogeneity.

Five studies reporting on 398 patients with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae BSI showed significantly lower mortality in the tigecycline arm than in the control arm. The combined treatment with tigecycline may be considered the optimal option for severely ill patients with BSI.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5382384/pdf/12941_2017_Article_199.pdf

July 2, 2017 at 9:31 pm

Prevalence of multidrug-resistant gram-negative bacteria among nursing home residents: A systematic review and meta-analysis.

American Journal of Infection Control May 1, 2017 V.45 N.5 P.512-518

Sainfer Aliyu, MPhil, MSEd, MHPM, BSN, RN’MPhil, MSEd, MHPM, BSN, RN Sainfer Aliyu, MSEd, MHPM, BSN, RN Sainfer Aliyu, Arlene Smaldone, PhD, CPNP, CDE, Elaine Larson, PhD, RN, CIC, FAAN

Highlights

  • Multidrug resistant-gram negative bacteria colonization ranged from 11.2%-59.1%.
  • E coli accounted for the largest proportion of isolates.
  • The most common site of colonization was rectal, followed by nasal, sputum, urinary tract and wound.
  • Colonization was significantly higher in studies conducted in United States (38%) compared to other countries (14%).

Background

Multidrug-resistant gram-negative bacteria (MDR-GNB) are associated with an increasing proportion of infections among nursing home (NH) residents. The objective of this systematic review and meta-analysis was to critically review evidence of the prevalence of MDR-GNB among NH residents.

Methods

Following Meta-Analysis of Observational Studies in Epidemiology guidelines, a systematic review of literature for the years 2005-2016 using multiple databases was conducted. Study quality, appraised by 2 reviewers, used Downs and Black risk of bias criteria. Studies reporting prevalence of MDR-GNB colonization were pooled using a random effects meta-analysis model. Heterogeneity was assessed using Cochran Q and I2 statistics.

Results

Of 327 articles, 12 met the criteria for review; of these, 8 met the criteria for meta-analysis. Escherichia coli accounted for the largest proportion of isolates. Reported MDR-GNB colonization prevalence ranged from 11.2%-59.1%. Pooled prevalence for MDR-GNB colonization, representing data from 2,720 NH residents, was 27% (95% confidence interval, 15.2%-44.1%) with heterogeneity (Q = 405.6; P = .01; I2 = 98.3). Two studies reported MDR-GNB infection rates of 10.9% and 62.7%.

Conclusion

Our findings suggest a high prevalence of MDR-GNB colonization among NH residents, emphasizing the need to enhance policies for infection control and prevention (ICP) in NHs.

FULL TEXT

http://www.ajicjournal.org/article/S0196-6553(17)30085-8/fulltext

PDF

http://www.ajicjournal.org/article/S0196-6553(17)30085-8/pdf

 

June 9, 2017 at 8:08 am

Intravenous fosfomycin-back to the future. Systematic review and meta-analysis of the clinical literature.

Clin Microbiol Infect. 2016 Dec 9. pii: S1198-743X(16)30610-3

Grabein B1, Graninger W2, Rodríguez Baño J3, Dinh A4, Liesenfeld DB5.

Author information

1 Department of Clinical Microbiology and Hospital Hygiene, Munich University Hospital, Munich, Germany.

2 Institute for Infectiology, Karl Landsteiner Society, Vienna, Austria.

3 Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitarios Virgen Macarena y Virgen del Rocío, Departamento de Medicina, Universidad de Sevilla-IBIS, Sevilla, Spain; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.

4 Infectious Disease Unit, R. Poincaré University Hospital, Garches, AP-HP, Versailles Saint Quentin University, Garches, France.

5 InfectoPharm Arzneimittel und Consilium GmbH, Heppenheim, Germany. Electronic address: david.liesenfeld@infectopharm.de

Abstract

OBJECTIVES:

We conducted a systematic review and meta-analysis to summarize the clinical evidence and usage patterns of intravenous fosfomycin from its development to the present time.

METHODS:

PubMed, the Cochrane Library and local journals were searched for relevant studies reporting aggregated data of intravenous fosfomycin use in adults and children, with no restrictions regarding study design. Single case reports were excluded. Data were systematically abstracted for all included studies. Clinical and microbiological efficacy from randomized controlled and comparative observational studies were synthesized using meta-analysis to calculate pooled effect sizes.

RESULTS:

In all, 128 studies on intravenous fosfomycin in 5527 patients were evaluated. Fosfomycin was predominantly used for sepsis/bacteraemia, urinary tract, respiratory tract, bone and joint, and central nervous system infections. No difference in clinical (OR 1.44, 95% CI 0.96-2.15) or microbiological (OR 1.28, 95% CI 0.82-2.01) efficacy between fosfomycin and other antibiotics was observed in comparative trials. The pooled estimate for resistance development during fosfomycin monotherapy was 3.4% (95% CI 1.8%-5.1%). Fosfomycin showed a favourable safety profile, with generally mild adverse events not requiring discontinuation of treatment. Included studies explored intravenous fosfomycin as an anti-staphylococcal agent in monotherapy and combination therapy, whereas studies from 1990 focused on combination therapy (fosfoymcin + β-lactams or aminoglycosides) for challenging infections frequently caused by multidrug-resistant organisms.

CONCLUSION:

Intravenous fosfomycin can play a vital role in the antibiotic armamentarium, given its long history of effective and safe use. However, well-designed randomized controlled trials are still desired.

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)30610-3/pdf

May 7, 2017 at 2:55 pm

Impact of Outpatient Neuraminidase Inhibitor Treatment in Patients Infected With Influenza A(H1N1)pdm09 at High Risk of Hospitalization: An Individual Participant Data Metaanalysis

Clin Inf Dis May 15, 2017 V.64 N.10

Sudhir Venkatesan; Puja R. Myles; Jo Leonardi-Bee; Stella G. Muthuri; Malak Al Masri …

Our findings suggest that in populations at high risk for hospital admission, patients with laboratory-confirmed or clinically diagnosed A(H1N1)pdm09 infection, NAI treatment in the community or outpatient settings is associated with reduced likelihood of subsequent hospital admission.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/64/10/10.1093_cid_cix127/2/cix127.pdf?Expires=1494188549&Signature=C1lJwO5DTqetonZJ1EBrasGE02emxNtMuALRrsBqQASk87ncDxVT-OPeLlOr-9rWN89CcNGSB2E24n65kRl7Y0ull44SP2nt5mSsSVpC8Mr4fiTdhjhLypKXHCGXFAk4PG1C8pwTJmUJP1j9S82X0SEqvhoVEX4iTwPv8bD2We2Kj1Mm9q5aGgKwoEwtWn6ekecNWsppLlOyrqJyQO5BYvF3sokrTWwlK8yMvmNT0OG8HDDnjrE48tRu0-d8DWiqBRcvAHyruu3M-hQKWXsotEjl~HHnoiN-un1FagEPkIbkKLraR3YBW9qWgup7cJADyg5EUvK58Lm2R4-XfiYNYg__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

May 6, 2017 at 3:56 pm

Long-term outcomes of infective encephalitis in children: a systematic review and meta-analysis.

Dev Med Child Neurol. 2016 Nov;58(11):1108-1115.

 doi: 10.1111/dmcn.13197. Epub 2016 Jul 16.

Khandaker G1,2,3, Jung J4, Britton PN4,5,6, King C7, Yin JK7,8, Jones CA4,5,6.

Author information

1Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. gulam.khandaker@health.nsw.gov.au

2National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Sydney, NSW, Australia. gulam.khandaker@health.nsw.gov.au

3Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Sydney, NSW, Australia. gulam.khandaker@health.nsw.gov.au

4Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.

5Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Sydney, NSW, Australia.

6Department of Infectious Diseases and Microbiology, The Children’s Hospital at Westmead, Sydney, NSW, Australia.

7National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Sydney, NSW, Australia.

8Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.

Abstract

AIM:

The long-term outcomes of childhood infective encephalitis are variable and not well quantified. We aimed to systematically review the literature and undertake meta-analyses on predetermined outcomes to address this knowledge gap and identify areas for future research.

METHOD:

We searched electronic databases, performed complementary reviews of references of fully extracted articles, and made contact with experts on infective encephalitis. Articles published up until April 2016 were selected for screening.

RESULTS:

We evaluated sequelae of 1018 survivors of childhood infective encephalitis (934 with complete follow-up) from 16 studies. Mean age during acute encephalitis episodes was 5 years 3.6 months (range 1.2mo-17y), 57.6% were male (500/868), and mean follow-up period was 4 years 1.2 months (range 1-12y). Incomplete recovery was reported in 312 children (42.0%; 95% confidence interval [CI] 31.6-53.1% in pooled estimate). Among the other sequelae, developmental delay, abnormal behaviour, motor impairment, and seizures were reported among 35.0% (95% CI 10.0-65.0%), 18.0% (95% CI 8.0-31.0%), 17.0% (95% CI 10.0-26.0%), and 10.0% (95% CI 6.0-14.0%) respectively.

INTERPRETATION:

Almost half of childhood infective encephalitis survivors report incomplete recovery in the long-term; most commonly developmental delay, behavioural abnormality, and neurological impairments (i.e. seizure). Well designed, large-scale prospective studies are needed to better quantify neurodevelopmental sequelae among childhood encephalitis survivors.

PDF

http://onlinelibrary.wiley.com/doi/10.1111/dmcn.13197/epdf

February 24, 2017 at 12:22 pm

Safety, tolerability, and efficacy of repeated doses of dihydroartemisinin-piperaquine for prevention and treatment of malaria: a systematic review and meta-analysis

Lancet Infectious Diseases February 2017 V.17 N.2 P.184–193

Julie Gutman, MD,  Stephanie Kovacs, PhD, Prof Grant Dorsey, MD, Prof Andy Stergachis, PhD, Prof Feiko O ter Kuile, MD

Background

Intermittent preventive treatment (IPT) for malaria is used in infants, children, adults, and pregnant women. Dihydroartemisinin-piperaquine (DP) is an effective, well tolerated artemisinin-based combination therapy. The long half-life of piperaquine makes it attractive for IPT. We conducted a systematic review and meta-analysis to establish the efficacy and safety of repeated treatment with DP.

Methods

Following PRISMA guidelines, we searched multiple databases on Sept 1, 2016, with the terms: “human” AND “dihydroartemisinin-piperaquine” OR “DHA-PPQ”. Studies were eligible if they were randomised controlled trials (RCTs) or prospective cohort studies involving repeat exposures to standard 3-day courses of DP for either seasonal malaria chemoprevention, mass drug administration, or treatment of clinical malaria, conducted at any time and in any geographic location. Random-effects meta-analysis was used to generate pooled incidence rate ratios and relative risks, or risk differences.

Findings

11 studies were included: two repeat treatment studies (one in children younger than 5 years and one in pregnant women), and nine IPT trials (five in children younger than 5 years, one in schoolchildren, one in adults, two in pregnant women). Comparator interventions included placebo, artemether-lumefantrine, sulfadoxine-pyrimethamine (SP), SP+amodiaquine, SP+piperaquine, SP+chloroquine, and co-trimoxazole. Of 14 628 participants, 3935 received multiple DP courses (2–18). Monthly IPT-DP was associated with an 84% reduction in the incidence of malaria parasitaemia measured by microscopy compared with placebo. Monthly IPT-DP was associated with fewer serious adverse events than placebo, daily co-trimoxazole, or monthly SP. Among 56 IPT-DP recipients (26 children, 30 pregnant women) with cardiac parameters, all QTc intervals were within normal limits, with no significant increase in QTc prolongation with increasing courses of DP.

Interpretation

Monthly DP appears well tolerated and effective for IPT. Additional data are needed in pregnancy and to further explore the cardiac safety with monthly dosing.

Funding

Bill & Melinda Gates Foundation and NIH.

FULL TEXT

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30378-4/fulltext?elsca1=etoc

PDF

http://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(16)30378-4.pdf

February 1, 2017 at 2:09 pm

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