Posts filed under ‘Meta-Análisis’

Global etiology of bacterial meningitis: A systematic review and meta-analysis.

PLoS One. 2018 Jun 11;13(6):e0198772.

Oordt-Speets AM1, Bolijn R1, van Hoorn RC1, Bhavsar A2, Kyaw MH3.

Abstract

Bacterial meningitis is a global public health concern, with several responsible etiologic agents that vary by age group and geographical area. The aim of this systematic review and meta-analysis was to assess the etiology of bacterial meningitis in different age groups across global regions.

PubMed and EMBASE were systematically searched for English language studies on bacterial meningitis, limited to articles published in the last five years. The methodological quality of the studies was assessed using a customized scoring system.

Meta-analyses were conducted to determine the frequency (percentages) of seven bacterial types known to cause meningitis: Escherichia coli, Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae, group B Streptococcus agalactiae, Staphylococcus aureus, and Listeria monocytogenes, with results being stratified by six geographical regions as determined by the World Health Organization, and seven age groups.

Of the 3227 studies retrieved, 56 were eligible for the final analysis. In all age groups, S. pneumoniae and N. meningitidis were the predominant pathogens in all regions, accounting for 25.1-41.2% and 9.1-36.2% of bacterial meningitis cases, respectively. S. pneumoniae infection was the most common cause of bacterial meningitis in the ‘all children’ group, ranging from 22.5% (Europe) to 41.1% (Africa), and in all adults ranging from 9.6% (Western Pacific) to 75.2% (Africa).

E. coli and S. pneumoniae were the most common pathogens that caused bacterial meningitis in neonates in Africa (17.7% and 20.4%, respectively). N. meningitidis was the most common in children aged ±1-5 years in Europe (47.0%).

Due to paucity of data, meta-analyses could not be performed in all age groups for all regions. A clear difference in the weighted frequency of bacterial meningitis cases caused by the different etiological agents was observed between age groups and between geographic regions.

These findings may facilitate bacterial meningitis prevention and treatment strategies.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995389/pdf/pone.0198772.pdf

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July 19, 2018 at 3:39 pm

Association Between CMV Reactivation and Clinical Outcomes in Immunocompetent Critically Ill Patients – Systematic Review and Meta-Analysis July 2018

Background

The aim of our systematic review was to investigate the association between cytomegalovirus (CMV) reactivation and outcomes in immunocompetent critically ill patients.

Methods

We searched electronic databases and gray literature for original studies and abstracts published between 1990 and October 2016. The review was limited to studies including critically ill immunocompetent patients. Cytomegalovirus reactivation was defined as positive polymerase chain reaction, pp65 antigenemia, or viral culture from blood or bronchoalveolar lavage. Selected patient-centered outcomes included mortality, duration of mechanical ventilation, need for renal replacement therapy (RRT), and nosocomial infections. Health resource utilization outcomes included intensive care unit and hospital lengths of stay.

Results

Twenty-two studies were included. In our primary analysis, CMV reactivation was associated with increased ICU mortality (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.87–3.47), overall mortality (OR, 2.02; 95% CI, 1.60–2.56), duration of mechanical ventilation (mean difference 6.60 days; 95% CI, 3.09–10.12), nosocomial infections (OR, 3.20; 95% CI, 2.05–4.98), need for RRT (OR, 2.37; 95% CI, 1.31–4.31), and ICU length of stay (mean difference 8.18 days; 95% CI, 6.14–10.22). In addition, numerous sensitivity analyses were performed.

Conclusions

In this meta-analysis, CMV reactivation was associated with worse clinical outcomes and greater health resource utilization in critically ill patients. However, it remains unclear whether CMV reactivation plays a causal role or if it is a surrogate for more severe illness.

https://academic.oup.com/ofid/article/4/2/ofx029/2991368

PDF (CLIC en PDF)

July 15, 2018 at 3:48 pm

Selective digestive and oropharyngeal decontamination in medical and surgical ICU patients: individual patient data meta-analysis

Clinical Microbiology abd Infection May 2018 V.24 N.5 P.505-513

N.L. Plantinga, A.M.G.A. de Smet, E.A.N. Oostdijk, E. de Jonge, C. Camus, W.A. Krueger, D. Bergmans, J.B. Reitsma, M.J.M. Bonten

Objectives

Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) improved intensive care unit (ICU), hospital and 28-day survival in ICUs with low levels of antibiotic resistance. Yet it is unclear whether the effect differs between medical and surgical ICU patients.

Methods

In an individual patient data meta-analysis, we systematically searched PubMed and included all randomized controlled studies published since 2000. We performed a two-stage meta-analysis with separate logistic regression models per study and per outcome (hospital survival and ICU survival) and subsequent pooling of main and interaction effects.

Results

Six studies, all performed in countries with low levels of antibiotic resistance, yielded 16 528 hospital admissions and 17 884 ICU admissions for complete case analysis. Compared to standard care or placebo, the pooled adjusted odds ratios for hospital mortality was 0.82 (95% confidence interval (CI) 0.72–0.93) for SDD and 0.84 (95% CI 0.73–0.97) for SOD. Compared to SOD, the adjusted odds ratio for hospital mortality was 0.90 (95% CI 0.82–0.97) for SDD. The effects on hospital mortality were not modified by type of ICU admission (p values for interaction terms were 0.66 for SDD and control, 0.87 for SOD and control and 0.47 for SDD and SOD). Similar results were found for ICU mortality.

Conclusions

In ICUs with low levels of antibiotic resistance, the effectiveness of SDD and SOD was not modified by type of ICU admission. SDD and SOD improved hospital and ICU survival compared to standard care in both patient populations, with SDD being more effective than SOD.

FULL TEXT

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(17)30477-9/fulltext

PDF

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(17)30477-9/pdf

 

June 12, 2018 at 8:07 am

Inappropriate Management of Asymptomatic Patients With Positive Urine Cultures: A Systematic Review and Meta-analysis

Open Forum Infectious Diseases Fall 2017 V.4 N.4

Myrto Eleni Flokas; Nikolaos Andreatos; Michail Alevizakos; Alireza Kalbasi; Pelin Onur …

Fundamento

La mala gestión de pacientes asintomáticos con cultivos de orina positivos (denominada bacteriuria asintomática [ASB] en la literatura) promueve la resistencia a los antimicrobianos y da como resultado eventos adversos innecesarios relacionados con los antimicrobianos y mayores costos de atención médica.

Métodos

Llevamos a cabo una revisión sistemática y un metanálisis de estudios que informaron sobre la tasa de tratamiento ASB inapropiado publicado entre 2004 y agosto 2016. La idoneidad de la administración de antimicrobianos se basó en las guias publicadas por la Sociedad de Enfermedades Infecciosas de América (IDSA).

Resultados

Se identificaron 2142 artículos no duplicados, y entre ellos 30 cumplieron nuestros criterios de inclusión. La prevalencia combinada del tratamiento antimicrobiano entre 4129 casos que no requirieron tratamiento fue del 45% (IC 95%, 39-50). Aislamiento de BGN (odds ratio [OR], 3,58; IC del 95%, 2,12-6,06), piuria (OR, 2,83; IC del 95%, 1,9-4,22), positividad del nitrito (OR, 3,83; IC del 95%; 2.24-6.54), y el sexo femenino (OR, 2.11, IC 95%, 1.46-3.06) aumentaron las probabilidades de recibir tratamiento. Las tasas de tratamiento fueron más altas en estudios con valores de corte de ≥ 100 000 ufc/ml en comparación con < 10 000 ufc/ml para el crecimiento bacteriano (P, 0,011). La implementación de intervenciones educativas y organizacionales diseñadas para eliminar el sobretratamiento de ASB resultó en una reducción media del riesgo absoluto del 33% (rangeARR, 16-36%, medianaRRR, 53%; rangeRRR, 25-80%).

Conclusión

La mala gestión de ASB sigue siendo extremadamente frecuente. El sexo femenino y la sobreinterpretación de ciertos datos de laboratorio (nitritos positivos, piuria, aislamiento de bacterias gramnegativas y cultivos con mayor recuento microbiano) están asociados con el sobretratamiento. Incluso las intervenciones simples de mayordomía pueden ser particularmente efectivas, y los programas de administración de antimicrobianos deben enfocarse en el desafío de diferenciar la infección verdadera del tracto urinario de ASB.

FULL TEXT

https://academic.oup.com/ofid/article/4/4/ofx207/4641888

PDF  (CLIC en PDF)

 

April 9, 2018 at 1:13 pm

C-reactive protein level predicts mortality in COPD – systematic review and meta-analysis

European Respiratory Review 31 March 2017 V.26 N.143   

El nivel de PCR predice la mortalidad en la EPOC – revisión sistemática y metanálisis

Giovanni Leuzzi, Carlotta Galeone, Francesca Taverna, Paola Suatoni, Daniele Morelli, Ugo Pastorino

El papel pronóstico de la proteína C-reactiva (PCR) en la EPOC es controvertido.

Para aclarar este problema, se realizó una revisión sistemática y un metanálisis para evaluar el efecto predictivo del nivel de PCR inicial en pacientes con EPOC. 15 artículos elegibles que se centran en la mortalidad tardía en la EPOC se incluyeron en nuestro estudio.

Realizamos un metanálisis de efectos aleatorios y evaluamos la heterogeneidad y el sesgo de publicación. Se combinaron las estimaciones de la razón de riesgo (HR) y sus intervalos de confianza del 95% sobre la mortalidad para la comparación entre la categoría más alta de PCR del estudio específico frente a la categoría más baja.

En el análisis general, los niveles elevados de PCR basales se asociaron significativamente con una mayor mortalidad (HR 1,53; IC del 95%: 1,32-1,77; I2 = 68,7%; p <0,001). Se observaron resultados similares en todos los subgrupos. Sin embargo, se informó un mayor riesgo de mortalidad en los estudios que utilizaron un valor de corte de 3 mg · L-1 (HR 1.61, IC 95% 1.12-2.30) y en aquellos que reclutaron una población asiática (HR 3.51, IC 95% 1.69-7.31 )

Nuestro análisis indica que el nivel de PCR alto basal se asocia significativamente con una mayor mortalidad tardía en pacientes con EPOC. Se necesitan más estudios controlados prospectivos para confirmar estos datos.

FULL TEXT

http://err.ersjournals.com/content/26/143/160070

PDF

http://err.ersjournals.com/content/errev/26/143/160070.full.pdf

 

March 25, 2018 at 4:35 pm

Linezolid versus vancomycin or teicoplanin for nosocomial pneumonia: a systematic review and meta-analysis.

Crit Care Med. 2010 Sep;38(9):1802-8.

Kalil AC1, Murthy MH, Hermsen ED, Neto FK, Sun J, Rupp ME.

Author information

1 University of Nebraska Medical Center, Omaha, NE, USA. akalil@unmc.edu

Abstract

INTRODUCTION:

Compared with glycopeptides, linezolid achieves higher lung epithelial lining fluid concentrations, which may correlate with improved efficacy in the treatment of nosocomial pneumonia. However, clinical superiority has not been demonstrated.

OBJECTIVE:

To test the hypothesis that linezolid may be superior to glycopeptides.

METHODS:

Prospective randomized trials that tested linezolid vs. vancomycin or teicoplanin for treatment of nosocomial pneumonia were included. Heterogeneity was analyzed by I(2) and Q statistics. Meta-analysis relative risks were based on fixed and random-effects models. Outcomes evaluated consisted of clinical cure, microbiological eradication, and side effects.

RESULTS:

Nine linezolid trials (vancomycin [7]; teicoplanin [2]) were included (n = 2329). The linezolid vs. glycopeptide analysis shows clinical cure relative risk of 1.01 (95% confidence interval, 0.93-1.10; p = .83; I(2) = 0%) and microbiological eradication relative risk of 1.10 (95% confidence interval, 0.98 -1.22; p = .10; I(2) = 0%). Methicillin-resistant Staphylococcus aureus subgroup analysis yielded a microbiological eradication relative risk of 1.10 (95% confidence interval, 0.87-1.38; p = .44; I(2) = 16%). If linezolid is compared with vancomycin only, then clinical cure relative risk is 1.00 (95% confidence interval, 0.90-1.12), microbiological eradication and methicillin-resistant Staphylococcus aureus relative risks are 1.07 (95% confidence interval, 0.90-1.26; p = .45) and 1.05 (95% confidence interval, 0.82-1.33; p = .71). The risks of thrombocytopenia (relative risk, 1.93; 95% confidence interval, 1.30-2.87; p = .001) and gastrointestinal events (relative risk, 2.02; 95% confidence interval, 1.10-3.70; p = .02) are higher with linezolid, but no differences are seen for renal dysfunction (relative risk, 0.89; 95% confidence interval, 0.56-1.43; p = .64) or all-cause mortality (relative risk, 0.95; 95% confidence interval, 0.76-1.18; p = .63).

CONCLUSIONS:

Our study does not demonstrate clinical superiority of linezolid vs. glycopeptides for the treatment of nosocomial pneumonia despite a statistical power of 95%. Linezolid shows a significant two-fold increase in the risk of thrombocytopenia and gastrointestinal events. Vancomycin and teicoplanin are not associated with more renal dysfunction than linezolid.

abstract

https://insights.ovid.com/pubmed?pmid=20639754

FULL TEXT

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0029911/

March 24, 2018 at 10:56 am

Clinical failure with and without empiric atypical bacteria coverage in hospitalized adults with community-acquired pneumonia: a systematic review and meta-analysis.

BMC Infect Dis. 2017 Jun 2;17(1):385.

Eljaaly K1,2, Alshehri S3,4, Aljabri A3,4, Abraham I4, Al Mohajer M5, Kalil AC6, Nix DE4,5.

Author information

1 Department of Clinical Pharmacy, King Abdulaziz University, P.O. Box 80200, Jeddah, Postal code 21589, Saudi Arabia. keljaaly@kau.edu.sa.

2 College of Pharmacy, University of Arizona, Drachman Hall – B306, 1295 N Martin Ave, P.O.Box 210202, Tucson, AZ, USA. keljaaly@kau.edu.sa.

3 Department of Clinical Pharmacy, King Abdulaziz University, P.O. Box 80200, Jeddah, Postal code 21589, Saudi Arabia.

4 College of Pharmacy, University of Arizona, Drachman Hall – B306, 1295 N Martin Ave, P.O.Box 210202, Tucson, AZ, USA.

5 Division of Infectious Diseases, Department of Medicine, University of Arizona, Tucson, AZ, USA.

6 Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA.

Abstract

BACKGROUND:

Both typical and atypical bacteria can cause community-acquired pneumonia (CAP); however, the need for empiric atypical coverage remains controversial. Our objective was to evaluate the impact of antibiotic regimens with atypical coverage (a fluoroquinolone or combination of a macrolide/doxycycline with a β-lactam) to a regimen without atypical antibiotic coverage (β-lactam monotherapy) on rates of clinical failure (primary endpoint), mortality, bacteriologic failure, and adverse events, (secondary endpoints).

METHODS:

We searched the PubMed, EMBASE and Cochrane Library databases for relevant RCTs of hospitalized CAP adults. We estimated risk ratios (RRs) with 95% confidence intervals (CIs) using a fixed-effect model, but used a random-effects model if significant heterogeneity (I 2 ) was observed.

RESULTS:

Five RCTs with a total of 2011 patients were retained. A statistically significant lower clinical failure rate was observed with empiric atypical coverage (RR, 0.851 [95% CI, 0.732-0.99; P = 0.037]; I 2  = 0%). The secondary outcomes did not differ between the two study groups: mortality (RR = 0.549 [95% CI, 0.259-1.165, P = 0.118], I 2  = 61.434%) bacteriologic failure (RR = 0.816 [95% CI, 0.523-1.272, P = 0.369], I 2  = 0%), diarrhea (RR = 0.746 [95% CI, 0.311-1.790, P = 0.512], I 2  = 65.048%), and adverse events requiring antibiotic discontinuation (RR = 0.83 [95% CI, 0.542-1.270, P = 0.39], I 2  = 0%).

CONCLUSIONS:

Empiric atypical coverage was associated with a significant reduction in clinical failure in hospitalized adults with CAP. Reduction in mortality, bacterial failure, diarrhea, and discontinuation due to adverse effects were not significantly different between groups, but all estimates favored atypical coverage. Our findings provide support for the current guidelines recommendations to include empiric atypical coverage.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457549/pdf/12879_2017_Article_2495.pdf

March 20, 2018 at 8:48 am

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