Posts filed under ‘Meta-Análisis’

REVIEW ARTICLE – PCT to Distinguish Viral From Bacterial Pneumonia – Systematic Review and Meta-analysis 

Clin Infect Dis, 1 February 2020, V.70 N.3, P.538–542

Because of the diverse etiologies of community-acquired pneumonia (CAP) and the limitations of current diagnostic modalities, serum procalcitonin levels have been proposed as a novel tool to guide antibiotic therapy. Outcome data from procalcitonin-guided therapy trials have shown similar mortality, but the essential question is whether the sensitivity and specificity of procalcitonin levels enable the practitioner to distinguish bacterial pneumonia, which requires antibiotic therapy, from viral pneumonia, which does not. In this meta-analysis of 12 studies in 2408 patients with CAP that included etiologic diagnoses and sufficient data to enable analysis, the sensitivity and specificity of serum procalcitonin were 0.55 (95% confidence interval [CI], .37–.71; I2 = 95.5%) and 0.76 (95% CI, .62–.86; I2 = 94.1%), respectively. Thus, a procalcitonin level is unlikely to provide reliable evidence either to mandate administration of antibiotics or to enable withholding such treatment in patients with CAP.

FULL TEXT

https://academic.oup.com/cid/article/70/3/538/5523199

PDF (CLIC en PDF)

March 24, 2020 at 8:47 pm

Group B Streptococcus in surgical site and non-invasive bacterial infections worldwide: A systematic review and meta-analysis

International Journal of Infectious Diseases June 2019 V.83 P.116-129

Simon M. Collin, Nandini Shetty, Rebecca Guy, Victoria N. Nyaga, Ann Bull, Michael J. Richards, Tjallie I.I. van der Kooi, Mayke B.G. Koek, Mary De Almeida, Sally A. Roberts, Theresa Lamagni

Highlights

  • This review obtained data on group B Streptococcus infection from 67 countries.
  • Group B Streptococcus is implicated in a small proportion of non-invasive infections.
  • Group B Streptococcus causes 10% of caesarean section invasive surgical infections.

Objectives

The epidemiology of disease caused by group B Streptococcus (GBS; Streptococcus agalactiae) outside pregnancy and the neonatal period is poorly characterized. The aim of this study was to quantify the role of GBS as a cause of surgical site and non-invasive infections at all ages.

Methods

A systematic review (PROSPERO CRD42017068914) and meta-analysis of GBS as a proportion (%) of bacterial isolates from surgical site infection (SSI), skin/soft tissue infection (SSTI), urinary tract infection (UTI), and respiratory tract infection (RTI) was conducted.

Results

Seventy-four studies and data sources were included, covering 67 countries. In orthopaedic surgery, GBS accounted for 0.37% (95% confidence interval (CI) 0.08–1.68%), 0.87% (95% CI 0.33–2.28%), and 1.46% (95% CI 0.49–4.29%) of superficial, deep, and organ/space SSI, respectively. GBS played a more significant role as a cause of post-caesarean section SSI, detected in 2.92% (95% CI 1.51–5.55%), 1.93% (95% CI 0.97–3.81%), and 9.69% (95% CI 6.72–13.8%) of superficial, deep, and organ/space SSI. Of the SSTI isolates, 1.89% (95% CI 1.16–3.05%) were GBS. The prevalence of GBS in community and hospital UTI isolates was 1.61% (1.13–2.30%) and 0.73% (0.43–1.23%), respectively. GBS was uncommonly associated with RTI, accounting for 0.35% (95% CI 0.19–0.63%) of community and 0.27% (95% CI 0.15–0.48%) of hospital RTI isolates.

Conclusions

GBS is implicated in a small proportion of surgical site and non-invasive infections, but a substantial proportion of invasive SSI post-caesarean section.

FULL TEXT

https://www.ijidonline.com/article/S1201-9712(19)30187-0/fulltext

PDF

https://www.ijidonline.com/article/S1201-9712(19)30187-0/pdf

 

 

June 30, 2019 at 12:21 pm

Comparative efficacy and safety of treatment options for MDR and XDR Acinetobacter baumannii infections: a systematic review and network meta-analysis.

Journal of Antimicrobial Chemotherapy January 1, 2018 V.73 N.1 P.22-32.

Kengkla K1, Kongpakwattana K2, Saokaew S1,2,3,4, Apisarnthanarak A5, Chaiyakunapruk N2,3,6,4.

Abstract

OBJECTIVES:

To comprehensively compare and rank the efficacy and safety of available treatment options for patients with MDR and XDR Acinetobacter baumannii (AB) infection.

METHODS:

We searched PubMed, Embase and the Cochrane register of trials systematically for studies that examined treatment options for patients with MDR- and XDR-AB infections until April 2016. Network meta-analysis (NMA) was performed to estimate the risk ratio (RR) and 95% CI from both direct and indirect evidence. Primary outcomes were clinical cure and microbiological cure. Secondary outcomes were all-cause mortality and nephrotoxic and non-nephrotoxic adverse events.

RESULTS:

A total of 29 studies with 2529 patients (median age 60 years; 65% male; median APACHE II score 19.0) were included. Although there were no statistically significant differences between treatment options, triple therapy with colistin, sulbactam and tigecycline had the highest clinical cure rate. Colistin in combination with sulbactam was associated with a significantly higher microbiological cure rate compared with colistin in combination with tigecycline (RR 1.23; 95% CI 1.03-1.47) and colistin monotherapy (RR 1.21; 95% CI 1.06-1.38). No significant differences in all-cause mortality were noted between treatment options. Tigecycline-based therapy also appeared less effective for achieving a microbiological cure and is not appropriate for treating bloodstream MDR- and XDR-AB infections.

CONCLUSIONS:

Combination therapy of colistin with sulbactam demonstrates superiority in terms of microbiological cure with a safety profile similar to that of colistin monotherapy. Thus, our findings support the use of this combination as a treatment for MDR- and XDR-AB infections.

FULL TEXT

https://academic.oup.com/jac/article/73/1/22/4563557

PDF (CLIC en PDF)

 

March 16, 2019 at 11:15 am

Diagnostic value of symptoms and signs for identifying urinary tract infection in older adult outpatients: Systematic review and meta-analysis.

Journal of  Infection  November 2018 V.77 N.5 P.379-390.

Gbinigie OA1, Ordóñez-Mena JM2, Fanshawe TR3, Plüddemann A4, Heneghan C5.

Author information

1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom. Electronic address: oghenekome.gbinigie@phc.ox.ac.uk.

2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom. Electronic address: jose.ordonezmena@phc.ox.ac.uk.

3 Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom. Electronic address: thomas.fanshawe@phc.ox.ac.uk.

4 Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom. Electronic address: annette.pluddemann@phc.ox.ac.uk.

5 Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom. Electronic address: carl.heneghan@phc.ox.ac.uk.

Abstract

OBJECTIVES:

To critically appraise and evaluate the diagnostic value of symptoms and signs in identifying UTI in older adult outpatients, using evidence from observational studies.

METHODS:

We searched Medline and Medline in process, Embase and Web of Science, from inception up to September 2017. We included studies assessing the diagnostic accuracy of symptoms and/or signs in predicting UTI in outpatients aged 65 years and above. Study quality was assessed using the QUADAS-2 tool.

RESULTS:

We identified 15 eligible studies of variable quality, with a total of 12,039 participants (range 65-4259), and assessed the diagnostic accuracy of 66 different symptoms and signs in predicting UTI. A number of symptoms and signs typically associated with UTI, such as nocturia, urgency and abnormal vital signs, were of limited use in older adult outpatients. Inability to perform a number of acts of daily living were predictors of UTI: For example, disability in feeding oneself, + ve LR: 11.8 (95% CI 5.51-25.2) and disability in washing one’s hands and face, + ve LR: 6.84 (95% CI 4.08-11.5).

CONCLUSIONS:

The limited evidence of varying quality shows that a number of symptoms and signs traditionally associated with UTI may have limited diagnostic value in older adult outpatients.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203890/pdf/main.pdf

March 15, 2019 at 3:32 pm

Effectiveness of the ribavirin in treatment of hantavirus infections in the Americas and Eurasia: a meta-analysis

Virus disease. September 2014 V.25 N.3 P. 385–389

Marcos L. Moreli,corresponding author Ariany C. Marques-Silva, Vagner A. Pimentel, and Vivaldo G. da Costa

Virology Laboratory, Federal University of Goiás, Jataí, Brazil

Marcos L. Moreli, Email: rb.gfu.iataj@ileromlm

Hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS) are transmitted to humans through infection with the old- and new-world hantaviruses, respectively.

Together these diseases affect tens of thousands of people every year, and no specific treatment is available.

To investigate whether ribavirin treatment for hantaviruses infections decreases disease severity, we conducted a meta-analysis involving human and animal studies.

After defining the research protocol and criteria for inclusion/exclusion, we identified seven studies. We found that in groups with HPS who were treated with ribavirin, there was no significant reduction in mortality (RR 0.99, 95 % CI 0.60–1.61, I2 = 0 %).

On the other hand, for animal group with HPS-like disease, there was significant increase in survival (RR 0.05, 95 % CI 0.01–0.34, I2 = 0 %).

For animal group infected with the old-world hantaviruses, treated with ribavirin, there was a statistically significant increase in survival (RR 0.56, 95 % CI 0.42–0.76, I2 = 64 %).

Similarly, for humans with HFRS treated, there was increase in survival (RR 0.28, 95 % CI 0.08–1), although only a study exist.

Our meta-analysis provides data that should be interpreted with caution, partly due to the limited number of studies available.

Additionally, the results of the application of ribavirin in the population with HPS could not be determined, particularly in patients in the end stage of this disease.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4188213/pdf/13337_2014_Article_219.pdf

January 12, 2019 at 12:17 pm

Diagnostic value of symptoms and signs for identifying urinary tract infection in older adult outpatients: Systematic review and meta-analysis

Journal of Infection November 2018 V.77 N.5 P.379–390

Oghenekome A. Gbinigie, José M. Ordóñez-Mena, Thomas R. Fanshawe, Annette Plüddemann, Carl Heneghan

Highlights

  • Older adults may present atypically with UTI and making a diagnosis can be difficult.
  • There is limited authoritative guidance on how older adult outpatients present with UTI.
  • Symptoms and signs traditionally associated with UTI (e.g. nocturia, urgency and abnormal vital signs) may have limited utility in diagnosing these infections in older adult outpatients.
  • Disability in performing a number of acts of daily living may be better predictors of UTI; high quality studies should be conducted in this area to confirm this

Objectives

To critically appraise and evaluate the diagnostic value of symptoms and signs in identifying UTI in older adult outpatients, using evidence from observational studies.

Methods

We searched Medline and Medline in process, Embase and Web of Science, from inception up to September 2017. We included studies assessing the diagnostic accuracy of symptoms and/or signs in predicting UTI in outpatients aged 65 years and above. Study quality was assessed using the QUADAS-2 tool.

Results

We identified 15 eligible studies of variable quality, with a total of 12,039 participants (range 65–4259), and assessed the diagnostic accuracy of 66 different symptoms and signs in predicting UTI. A number of symptoms and signs typically associated with UTI, such as nocturia, urgency and abnormal vital signs, were of limited use in older adult outpatients. Inability to perform a number of acts of daily living were predictors of UTI: For example, disability in feeding oneself, + ve LR: 11.8 (95% CI 5.51–25.2) and disability in washing one’s hands and face, + ve LR: 6.84 (95% CI 4.08–11.5).

Conclusions

The limited evidence of varying quality shows that a number of symptoms and signs traditionally associated with UTI may have limited diagnostic value in older adult outpatients.

FULL TEXT

https://www.journalofinfection.com/article/S0163-4453(18)30190-7/fulltext

PDF

https://www.journalofinfection.com/article/S0163-4453(18)30190-7/pdf

January 12, 2019 at 9:59 am

Comparison Between Carbapenems and β-Lactam/β-Lactamase Inhibitors in the Treatment for Bloodstream Infections Caused by Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: A Systematic Review and Meta-Analysis

Open Forum Infect Dis. 16 May 2017;4(2):ofx099.

Muhammed M, Flokas ME, Detsis M, Alevizakos M, y col.  

Background.

Carbapenems are widely used for the management of bloodstream infections (BSIs) caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE). However, the wide use of carbapenems has been associated with carbapenem-resistant Enterobacteriaceae development.

Methods.

We searched the PubMed and Scopus databases (last search date was on June 1, 2016) looking for studies that reported mortality in adult patients with ESBL-PE BSIs that were treated with carbapenems or β-lactam/β-lactamase inhibitors (BL/BLIs).

Results.

Fourteen studies reported mortality data in adult patients with ESBL-PE BSI that were treated with carbapenems or BL/BLIs. Among them, 13 studies reported extractable data on empiric therapy, with no statistically significant difference in mortality of patients with ESBL-PE BSI that were treated empirically with carbapenems (22.1%; 121 of 547), compared with those that received empiric BL/BLIs (20.5%; 109 of 531; relative risk [RR], 1.05; 95% confidence interval [CI], 0.83–1.37; I2 = 20.7%; P = .241). In addition, 7 studies reported data on definitive therapy. In total, 767 patients (79.3%) received carbapenems and 199 patients (20.6%) received BL/BLIs as definitive therapy, and there was again no statistically significant difference (RR, 0.62; 95% CI, 0.25–1.52; I2 = 84.6%; P < .001). Regarding specific pathogens, the use of empiric BL/BLIs in patients with BSI due to ESBL-Escherichia coli was not associated with a statistically significant difference in mortality (RR, 1.014; 95% CI, 0.491–2.095; I2 = 62.5%; P = .046), compared with the use of empiric carbapenems.

Conclusions.

These data do not support the wide use of carbapenems as empiric therapy, and BL/BLIs might be effective agents for initial/empiric therapy for patients with BSI caused by likely ESBL-PE, and especially ESBL-E coli.

FULL TEXT

https://academic.oup.com/ofid/article/4/2/ofx099/3828264

PDF (HACER CLIC en PDF)

 

September 20, 2018 at 3:31 pm

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