Exposure to WHO AWaRe antibiotics and isolation of multi-drug resistant bacteria: a systematic review and meta-analysis
Abstract
BACKGROUND
Antibiotic use drives antibiotic resistance.
OBJECTIVES
To systematically review the literature and estimate associations between prior exposure to antibiotics across WHO AWaRe categories (Access, Watch, Reserve) and isolation of critical and high-priority multi-drug resistant organisms (MDROs) on the WHO priority pathogen list.
METHODS
Data sources: 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
Case-control, cohort or experimental studies that assessed the risk of infection/colonization with MDROs.
PARTICIPANTS
Inpatients or outpatients of any age and sex.
INTERVENTIONS
Prior exposure to antibiotics that could be categorized into the AWaRe framework.Assessment of risk of bias: Tailored design-specific checklists applied to each included study.
DATA SYNTHESIS
For each antibiotic/class, crude odds ratios (ORs) were pooled through random-effects meta-analyses, both overall and by MDRO. Heterogeneity was examined.
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…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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