Rodríguez-Baño, Jesús [0000-0001-6732-9001], Hassoun-Kheir, Nasreen, Guedes, Mariana, Ngo Nsoga, Marie Therese, Argante, Lorenzo, Arieti, Fabiana, Gladstone, Beryl Primrose, Kingston, Rhys, Naylor, Nichola R., Pezzani, Maria Diletta, Pouwels, Koen B., Robotham, Julie V., Rodríguez-Baño, Jesús, Tacconelli, Evelina, Vella, Venanzio, Harbarth, Stephan, Kraker, Marlieke de, PrIMAVeRa Work Package, Barana, Benedetta, Cappelli, Eva, De Rui, Maria Elena, El-Abasiri, Radwa A., Galia, Liliana, Geurtsen, Jeroen, Mejia, Jorly, Palladino, Andrea, Piljic, Alen, Rajendran, N. B., Reyna-Villasmil, Eduardo, Schmidt, Johannes, Rodríguez-Baño, Jesús [0000-0001-6732-9001], Hassoun-Kheir, Nasreen, Guedes, Mariana, Ngo Nsoga, Marie Therese, Argante, Lorenzo, Arieti, Fabiana, Gladstone, Beryl Primrose, Kingston, Rhys, Naylor, Nichola R., Pezzani, Maria Diletta, Pouwels, Koen B., Robotham, Julie V., Rodríguez-Baño, Jesús, Tacconelli, Evelina, Vella, Venanzio, Harbarth, Stephan, Kraker, Marlieke de, PrIMAVeRa Work Package, Barana, Benedetta, Cappelli, Eva, De Rui, Maria Elena, El-Abasiri, Radwa A., Galia, Liliana, Geurtsen, Jeroen, Mejia, Jorly, Palladino, Andrea, Piljic, Alen, Rajendran, N. B., Reyna-Villasmil, Eduardo, and Schmidt, Johannes
[Background] Antimicrobial resistance is a global threat, which requires novel intervention strategies, for which priority pathogens and settings need to be determined., [Objectives] We evaluated pathogen-specific excess health burden of drug-resistant bloodstream infections (BSIs) in Europe., [Methods] A systematic review and meta-analysis., [Data sources] MEDLINE, Embase, and grey literature for the period January 1990 to May 2022., [Study eligibility criteria] Studies that reported burden data for six key drug-resistant pathogens: carbapenem-resistant (CR) Pseudomonas aeruginosa and Acinetobacter baumannii, third-generation cephalosporin or CR Escherichia coli and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium. Excess health outcomes compared with drug-susceptible BSIs or uninfected patients. For MRSA and third-generation cephalosporin E. coli and K. pneumoniae BSIs, five or more European studies were identified. For all others, the search was extended to high-income countries., [Participants] Paediatric and adult patients diagnosed with drug-resistant BSI., [Interventions] Not applicable., [Assessment of risk of bias] An adapted version of the Joanna-Briggs Institute assessment tool., [Methods of data synthesis] Random-effect models were used to pool pathogen-specific burden estimates., [Results] We screened 7154 titles, 1078 full-texts and found 56 studies on BSIs. Most studies compared outcomes of drug-resistant to drug-susceptible BSIs (46/56, 82.1%), and reported mortality (55/56 studies, 98.6%). The pooled crude estimate for excess all-cause mortality of drug-resistant versus drug-susceptible BSIs ranged from OR 1.31 (95% CI 1.03–1.68) for CR P. aeruginosa to OR 3.44 (95% CI 1.62–7.32) for CR K. pneumoniae. Pooled crude estimates comparing mortality to uninfected patients were available for vancomycin-resistant Enterococcus and MRSA BSIs (OR of 11.19 [95% CI 6.92–18.09] and OR 6.18 [95% CI 2.10–18.17], respectively)., [Conclusions] Drug-resistant BSIs are associated with increased mortality, with the magnitude of the effect influenced by pathogen type and comparator. Future research should address crucial knowledge gaps in pathogen- and infection-specific burdens to guide development of novel interventions.