Respiratory investigation · 2026
Utility of risk assessment and identification of risk factors for drug-resistant pathogens in hospital-acquired and ventilator-associated pneumonia: systematic reviews and meta-analyses.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод в очереди
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Kawasuji Hitoshi, Maruyama Takaya, Aoki Nobumasa, Koshiyama Yuki, Nagaoka Kentaro, Katsurada Masahiro, Sano Masahiro, Shindo Yuichiro, Iwanaga Naoki, Horita Nobuyuki, Tsukada Hiroki, Matsumoto Tetsuya, Mukae Hiroshi, Yamamoto Yoshihiro
Аннотация
BACKGROUND: Although the identification of risk factors for drug-resistant (DR) pathogens is urgently needed, no systematic review and meta-analysis has comprehensively identified the key risk factors in hospital-acquired pneumonia and ventilator-associated pneumonia (HAP/VAP).
METHODS: We conducted two systematic reviews and meta-analyses (SRMAs) using five electronic databases. The first (SRMA 1) evaluated differences in clinical outcomes between HAP/VAP patients at high versus low-risk for DR pathogens. The second (SRMA 2) comprehensively identified significant risk factors for DR pathogens in HAP/VAP.
RESULTS: Among 1094 studies screened, seven prospective cohort studies comprising 1645 patients met the inclusion criteria for SRMA 1, and eight studies comprising 8646 patients met the criteria for SRMA 2. In SRMA 1, the rates of DR pathogen detection and all-cause mortality were significantly higher among high-risk than low-risk patients. In SRMA 2, five significant risk factors for DR pathogens were systematically identified among patients with culture-positive HAP/VAP: onset in the intensive care unit, sepsis/septic shock, previous antibiotics treatment, bedridden state or poor functional status, and chronic kidney disease (including that requiring hemodialysis).
CONCLUSIONS: Our findings in SRMA 1 support the clinical utility of risk assessment for DR pathogens in HAP/VAP. The five risk factors identified in SRMA 2 may serve as candidate predictors in future models aimed at guiding initial antibiotic selection.
CLINICAL TRIAL REGISTRATION: The study protocol was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN000057547).
METHODS: We conducted two systematic reviews and meta-analyses (SRMAs) using five electronic databases. The first (SRMA 1) evaluated differences in clinical outcomes between HAP/VAP patients at high versus low-risk for DR pathogens. The second (SRMA 2) comprehensively identified significant risk factors for DR pathogens in HAP/VAP.
RESULTS: Among 1094 studies screened, seven prospective cohort studies comprising 1645 patients met the inclusion criteria for SRMA 1, and eight studies comprising 8646 patients met the criteria for SRMA 2. In SRMA 1, the rates of DR pathogen detection and all-cause mortality were significantly higher among high-risk than low-risk patients. In SRMA 2, five significant risk factors for DR pathogens were systematically identified among patients with culture-positive HAP/VAP: onset in the intensive care unit, sepsis/septic shock, previous antibiotics treatment, bedridden state or poor functional status, and chronic kidney disease (including that requiring hemodialysis).
CONCLUSIONS: Our findings in SRMA 1 support the clinical utility of risk assessment for DR pathogens in HAP/VAP. The five risk factors identified in SRMA 2 may serve as candidate predictors in future models aimed at guiding initial antibiotic selection.
CLINICAL TRIAL REGISTRATION: The study protocol was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN000057547).