Colonisation with Extended-Spectrum Cephalosporin-Resistant Enterobacterales and Infection Risk in Surgical Patients: A Systematic Review and Meta-analysis

• Published in: Infectious diseases and therapy 2023-02, Vol.12 (2), p.623-636
• Main Authors: Righi, Elda, Scudeller, Luigia, Mirandola, Massimo, Visentin, Alessandro, Mutters, Nico T., Meroi, Marco, Schwabe, Anna, Erbogasto, Anna, Vantini, Gianluca, Cross, Elizabeth L.A., Giannella, Maddalena, Guirao, Xavier, Tacconelli, Evelina
• Format: Article
• Language: English
• Subjects: Antibiotics; Colonization; Epidemiology; Extended-spectrum cephalosporin-resistant Enterobacterales (ESCR-E); Health aspects; Health risks; Heterogeneity; Hospital patients; Infection; Infections; Infectious Diseases; Internal Medicine; Liver transplantation; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Meta-analysis; Metronidazole; Observational studies; Original Research; Postoperative infections; Rectal colonisation; Risk factors; Surgery; Surgical site infections; Systematic review
• ISSN: 2193-8229; 2193-6382
• DOI: 10.1007/s40121-022-00756-z

Introduction Limited evidence has been reported for surgical site infections (SSIs) in patients undergoing surgery who are carriers of extended-spectrum cephalosporin-resistant Enterobacterales (ESCR-E). A systematic review and meta-analysis were conducted to evaluate the risk of postoperative infections in adult inpatients colonised with ESCR-E before surgery. Methods The Medline, Embase and Cochrane databases were searched between January 2011 and April 2022, following PRISMA indications. Random effects meta-analysis was used to quantify the association between ESCR-E colonisation and infection. Results Among the 467 articles reviewed, 9 observational studies encompassing 7219 adult patients undergoing surgery were included. The ESCR-E colonisation rate was 13.7% (95% CI 7.7–19.7). The most commonly reported surgeries included abdominal surgery (44%) and liver transplantation (LT; 33%). The SSI rate was 23.2% (95% CI 13.2–33.1). Pooled incidence risk was 0.36 (95% CI 0.22–0.50) vs 0.13 (95% CI 0.02–0.24) for any postoperative infection and 0.28 (95% CI 0.18–0.38) vs 0.17 (95% CI 0.07–0.26) for SSIs in ESCR-E carriers vs noncarriers, respectively. In ESCR-E carriers, the ESCR-E infection ratio was 7 times higher than noncarriers. Postoperative infection risk was higher in carriers versus noncarriers following LT. Sources of detected heterogeneity between studies included ESCR-E colonisation and the geographic region of origin. Conclusions Patients colonised with ESCR-E before surgery had increased incidence rates of post-surgical infections and SSIs compared to noncarriers. Our results suggest considering the implementation of pre-surgical screening for detecting ESCR-E colonisation status according to the type of surgery and the local epidemiology.