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A Systematic Review of the Burden of Multidrug-Resistant Healthcare-Associated Infections Among Intensive Care Unit Patients in Southeast Asia: The Rise of Multidrug-Resistant Acinetobacter baumannii

Published online by Cambridge University Press:  27 March 2018

Nattawat Teerawattanapong ,
Pornpansa Panich ,
Disorn Kulpokin ,
Siriwat Na Ranong ,
Khachen Kongpakwattana ,
Atibodi Saksinanon ,
Bey-Hing Goh ,
Learn-Han Lee ,
Anucha Apisarnthanarak  and
Nathorn Chaiyakunapruk
Nattawat Teerawattanapong
Affiliation:
Division of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Ubon Ratchathani, Thailand School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
Pornpansa Panich
Affiliation:
Faculty of Pharmacy, Silpakorn University, Nakorn Pathom, Thailand
Disorn Kulpokin
Affiliation:
Faculty of Pharmacy, Silpakorn University, Nakorn Pathom, Thailand
Siriwat Na Ranong
Affiliation:
Faculty of Pharmacy, Prince of Songkla University, Songkla, Thailand
Khachen Kongpakwattana
Affiliation:
School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
Atibodi Saksinanon
Affiliation:
School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
Bey-Hing Goh
Affiliation:
School of Pharmacy, Monash University Malaysia, Selangor, Malaysia Asian Center for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-Being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia Center of Health Outcomes Research and Therapeutic Safety (COHORTS), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
Learn-Han Lee
Affiliation:
School of Pharmacy, Monash University Malaysia, Selangor, Malaysia Asian Center for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-Being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia Center of Health Outcomes Research and Therapeutic Safety (COHORTS), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
Anucha Apisarnthanarak
Affiliation:
Division of Infectious Diseases, Thammasat University Hospital, Pratumthani, Thailand
Nathorn Chaiyakunapruk*
Affiliation:
School of Pharmacy, Monash University Malaysia, Selangor, Malaysia Asian Center for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-Being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand School of Pharmacy, University of Wisconsin, Madison, Wisconsin, United States
*
Address correspondence to Nathorn Chaiyakunapruk, PharmD, PhD, Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand (chaiyakunapr@wisc.edu).
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Abstract

OBJECTIVE

To summarize the clinical burden (cumulative incidence, prevalence, case fatality rate and length of stay) and economic burden (healthcare cost) of healthcare-associated infections (HAIs) due to multidrug-resistant organisms (MDROs) among patients in intensive care units (ICUs) in Southeast Asia.

DESIGN

Systematic review.

METHODS

We conducted a comprehensive literature search in PubMed, EMBASE, CINAHL, EconLit, and the Cochrane Library databases from their inception through September 30, 2016. Clinical and economic burdens and study quality were assessed for each included study.

RESULTS

In total, 41 studies met our inclusion criteria; together, 22,876 ICU patients from 7 Southeast Asian countries were included. The cumulative incidence of HAI caused by A. baumannii (AB) in Southeast Asia is substantially higher than has been reported in other regions, especially carbapenem-resistant AB (CRAB; 64.91%) and multidrug-resistant AB (MDR-AB) (58.51%). Evidence of a dose–response relationship between different degrees of drug resistance and excess mortality due to AB infections was observed. Adjusted odds ratios were 1.23 (95% confidence interval [CI], 0.51–3.00) for MDR-AB, 1.72 (95% CI, 0.77–3.80) for extensively drug-resistant AB (XDR-AB), and 1.82 (95% CI, 0.55–6.00) for pandrug-resistant AB (PDR-AB). There is, however, a paucity of published data on additional length of stay and costs attributable to MDROs.

CONCLUSIONS

This review highlights the challenges in addressing MDROs in Southeast Asia, where HAIs caused by MDR gram-negative bacteria are abundant and have a strong impact on society. With our findings, we hope to draw the attention of clinicians and policy makers to the problem of antibiotic resistance and to issue a call for action in the management of MDROs.

Infect Control Hosp Epidemiol 2018;39:525–533

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 5 , May 2018 , pp. 525 - 533
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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