Revision sistemática: Factores asociados a colonización e infección por bacterias gram negativas resistentes a carbapenemicos

Abstract

INTRODUCTION: Carbapenems (CP) are considered as one of the last line of antibiotic treatment for several infections by multidrug-resistant pathogens. They have an important activity against extended-spectrum beta-lactamase-producing bacteria. There is growing worldwide concern because of widespread of gram negative carbapenem resistant (GNR-CP) isolations and few treatment options. In United States 60% of nosocomial infections are caused by multiressitent bacteria. In the European Union, about 25,000 patients anually die for this cause. In Latam there is a growing trend in resistance rate. AIM: Identify and describe risk factors or protective factors, related with colonization or infection by gram negative carbapenem resistant bacteria, for hospitalized adult patients, through a systematic review of literature.METHODS: A comprehensive search (PubMed, Embase, Scopus, BVS, Scielo and grey literature) was performed for articles that were published between 01/01/2004 and 15/04/2015, using the Newcastle-Ottawa scale and critical reading sheets (FLC) -Osteba for selection of articles.RESULTS: 36 high quality case- control studies, were founded. The risk factors identified were UCI stay OR 36.46 p <0.0001, acute renal failure OR 6.23 p 0.001, dialysis OR 10.80 p:0.03, mechanical ventilation OR 17.5 p<0.001, urinary catheter OR 14.3 p:0.001, carbapenems OR 18,52 p<0,001, quinolone OR 17.30 p:0.0008, cefepime OR:28.05 p:0.004, glyicopeptide OR:19.1 p<0.001, metronidazol OR:4.17 p0.03, colistin OR:12.1 p<0.001 and linezolid OR 7 p:0.01.CONCLUSIONS: High heterogeneity in risk factors in the studies and its classification limited the analysis, nevertheless it was easy concluded that colonization or nosocomial infection is related with a large list of risk factors, among the most important were acute renal failure, dialysis, mechanical ventilation, urinary catheter, ICU stay and previous use of antibiotics mainly carbapenems, quinolone, glycopetide, cefepime, metronidazol, linezolid and colistin.