Exposure to World Health Organization's AWaRe antibiotics and isolation of multidrug resistant bacteria: a systematic review and meta-analysis.
AWaRe framework
Antibiotic exposure
Antibiotic stewardship
Critical priority pathogens
High-priority pathogens
Multidrug resistant organisms
Resistance selection
Journal
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
ISSN: 1469-0691
Titre abrégé: Clin Microbiol Infect
Pays: England
ID NLM: 9516420
Informations de publication
Date de publication:
Sep 2022
Sep 2022
Historique:
received:
25
01
2022
revised:
10
03
2022
accepted:
12
03
2022
pubmed:
28
3
2022
medline:
20
9
2022
entrez:
27
3
2022
Statut:
ppublish
Résumé
Antibiotic use drives antibiotic resistance. To systematically review the literature and estimate associations between prior exposure to antibiotics across World Health Organization's (WHO) AWaRe categories (Access, Watch, Reserve) and isolation of critical and high-priority multidrug resistant organisms (MDROs) on the WHO priority pathogen list. Embase, Ovid Medline, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov (from inception to 20/08/2020). Case-control, cohort, or experimental studies that assessed the risk of infection/colonization with MDROs. Inpatients or outpatients of any age and sex. Prior exposure to antibiotics that could be categorized into the AWaRe framework. Tailored design-specific checklists applied to each included study. For each antibiotic/class, crude odds ratios (ORs) were pooled through random-effects meta-analyses, both overall and by MDRO. Heterogeneity was examined. We identified 349 eligible studies. All were observational, prone to bias due to design and lack of adjustment for confounding, and not primarily designed to compare associations across AWaRe categories. We found statistically significant associations between prior exposure to almost all antibiotics/classes across AWaRe categories and colonization/infection with any MDRO. We observed higher ORs for Watch and Reserve antibiotics than with Access antibiotics. First generation cephalosporins (Access) had the least association with any MDRO colonization/infection (58 studies; OR = 1.2 [95% CI: 1.0-1.4]), whereas strongest associations were estimated for linezolid (Reserve) (22 studies; OR = 2.6 [95% CI: 2.1-3.1]), followed by carbapenems (Watch) (237 studies; OR = 2.3 [95% CI: 2.1-2.5]). There was high heterogeneity for all antibiotic/MDRO associations. Optimising use of Access antibiotics is likely to reduce the selection of MDROs and global antibiotic resistance. Despite data limitations, our study offers a strong rationale for further adoption of AWaRe as an important tool to improve antibiotic use globally.
Sections du résumé
BACKGROUND
BACKGROUND
Antibiotic use drives antibiotic resistance.
OBJECTIVES
OBJECTIVE
To systematically review the literature and estimate associations between prior exposure to antibiotics across World Health Organization's (WHO) AWaRe categories (Access, Watch, Reserve) and isolation of critical and high-priority multidrug resistant organisms (MDROs) on the WHO priority pathogen list.
DATA SOURCES
METHODS
Embase, Ovid Medline, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov (from inception to 20/08/2020).
STUDY ELIGIBILITY CRITERIA
METHODS
Case-control, cohort, or experimental studies that assessed the risk of infection/colonization with MDROs.
PARTICIPANTS
METHODS
Inpatients or outpatients of any age and sex.
INTERVENTIONS
METHODS
Prior exposure to antibiotics that could be categorized into the AWaRe framework.
DATA ANALYSIS
METHODS
Tailored design-specific checklists applied to each included study. For each antibiotic/class, crude odds ratios (ORs) were pooled through random-effects meta-analyses, both overall and by MDRO. Heterogeneity was examined.
RESULTS
RESULTS
We identified 349 eligible studies. All were observational, prone to bias due to design and lack of adjustment for confounding, and not primarily designed to compare associations across AWaRe categories. We found statistically significant associations between prior exposure to almost all antibiotics/classes across AWaRe categories and colonization/infection with any MDRO. We observed higher ORs for Watch and Reserve antibiotics than with Access antibiotics. First generation cephalosporins (Access) had the least association with any MDRO colonization/infection (58 studies; OR = 1.2 [95% CI: 1.0-1.4]), whereas strongest associations were estimated for linezolid (Reserve) (22 studies; OR = 2.6 [95% CI: 2.1-3.1]), followed by carbapenems (Watch) (237 studies; OR = 2.3 [95% CI: 2.1-2.5]). There was high heterogeneity for all antibiotic/MDRO associations.
CONCLUSIONS
CONCLUSIONS
Optimising use of Access antibiotics is likely to reduce the selection of MDROs and global antibiotic resistance. Despite data limitations, our study offers a strong rationale for further adoption of AWaRe as an important tool to improve antibiotic use globally.
Identifiants
pubmed: 35339675
pii: S1198-743X(22)00153-7
doi: 10.1016/j.cmi.2022.03.014
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Carbapenems
0
Cephalosporins
0
Electrolytes
0
Linezolid
ISQ9I6J12J
Types de publication
Journal Article
Meta-Analysis
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1193-1202Subventions
Organisme : World Health Organization
ID : 001
Pays : International
Informations de copyright
Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.