Association between carbapenem-resistant Enterobacteriaceae and death: A systematic review and meta-analysis

Background: Carbapenem-resistant Enterobacteriaceae (CRE) has emerged in health care facilities around the world. Several studies demonstrated data regarding clinical outcomes for CRE infections including death. This systematic review and meta-analysis summarized literature discussing association between CRE and mortality. Methods: A systematic literature review was performed by searching EMBASE, International Pharmaceutical Abstract databases, PubMed, and Scopus and to identify studies that assessed the association between CRE and death published from April 2012 to October 2017. A meta-analysis was performed using a random effect model. Heterogeneity was assessed using the I-2-statistic. Results: Twenty-one studies were included in this meta-analysis. The underlying populations were moderately heterogeneous (I-2 = 60%; P= .01). Pooled risk estimates from 9 studies revealed a significant association between CRE and death (pooled-adjusted odds ratio: 2.85; 95% confidence interval: 1.88, 4.30). The unadjusted variable pooled from 18 studies demonstrated a significant association between CRE and death (pooled-unadjusted odds ratio: 3.73; 95% confidence interval: 2.02, 6.88). Discussion: The finding that CRE infection was positively associated with death agreed with the previous meta-analysis of studies published before April 2012. Conclusions: This meta-analysis found that CRE was associated with increased risk of death. Our analysis implies a need for strict infection control measures. (C) 2019 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.