Global Clinical Epidemiology of Carbapenem- Resistant Enterobacteriaceae Bacteremia and Association with Mortality: Systematic Review and Meta-Analysis

Objectives: This study was aimed to systematically review published data to evaluate the clinical epidemiology, to explore the risk factors for the acquisition of CRE bacteremia among hospitalized patients and to find out their association with mortality. Methods: The reports concerning the CRE bacteremia in hospitalized adult patients among the published literature before May 2019 were identified by a systematic search of Pubmed, EMBASE and Cochrane. Summary odds ratios(OR) were calculated using random effects models, and study quality was assessed using a modified Newcastle-Ottawa scale. Results: Totally 573 literatures were retrieved out, and we identified 42 studies to calculate the statistically significant pooled odds ratio, of which 22 papers describing factors for CRE-BSIs morbidity and 26 papers for mortality. Previous antibiotic exposure (OR 7.71; 95% CI 2.82-21.08; I-squared=87%), following by mechanical ventilation (OR 4.54; 95% CI 2.55, 8.08; I-squared=78%) and admission to ICU (OR 4.17; 95% CI 3.02-5.76; I-squared=72%) device generated the highest pooled estimate for CRE-BSIs morbidity. Underlying diseases or conditions lead to an unfortunate ending for patients with CRE-BSI. Appropriate empirical therapy contributed to reduce mortality for CRE-BSIs, and the use of ceftazidime-avibactam, lower Pitt bacteremia score or APACHE2 score were also relevant to control mortality. Conclusion: The worldwide morbidity and mortality for CRE-BSIs are high. We should standardize medical practices, optimize the therapeutic approach, timely monitor relevant indicators to control hospital outbreaks.