Factors associated with antimicrobial resistance in critically ill patients admitted to intensive care units: a systematic review and meta-analysis
Gustavo Sebastián Quinga Gómez y Diana Mercedes Cartuche Valladares
Estudiantes de Maestría. Pontífica Universidad Católica del Ecuador.
Resumen
Objetivo: Analizar los factores asociados a la resistencia a los antibióticos (RA) en pacientes adultos críticos en la Unidad de Cuidados Intensivos (UCI) mediante una revisión sistemática con metaanálisis.
Método: La metodología siguió los lineamientos PRISMA; se buscaron estudios de los últimos 10 años (español/inglés) en PubMed, Scopus, Web of Science, SciELO, LILACS y CINAHL usando MeSH/DeCS. Se extrajeron OR con IC95% y se evaluó la heterogeneidad (I²); dada la variabilidad, se aplicó un modelo de efectos aleatorios y análisis de sensibilidad; la calidad se valoró a través de la metodología de Jadad.
Resultados: En la búsqueda se identificaron 120 artículos; 50 pasaron a texto completo; se incluyeron 45 en el análisis cuantitativo. Los factores con mayor asociación con RA fueron: estancia en UCI >10 días (OR 2,90; IC95% 2,10–4,00; I² 71%), uso prolongado de antibióticos (OR 2,45; IC95% 1,80–3,30; I² 67%), catéter venoso central (OR 2,10; IC95% 1,60–2,80; I² 40%) y ventilación mecánica (OR 1,95; IC95% 1,40–2,70; I² 52%). Se reportaron con alta frecuencia Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii y Escherichia coli.
Conclusiones: La resistencia antimicrobiana en UCI es multifactorial y se relaciona con exposición a dispositivos invasivos, uso inadecuado/prolongado de antibióticos y estancias prolongadas. Programas de optimización de antimicrobianos, vigilancia y control de infecciones disminuyen el riesgo; el fortalecimiento organizacional y del equipo de enfermería es clave.
Método: La metodología siguió los lineamientos PRISMA; se buscaron estudios de los últimos 10 años (español/inglés) en PubMed, Scopus, Web of Science, SciELO, LILACS y CINAHL usando MeSH/DeCS. Se extrajeron OR con IC95% y se evaluó la heterogeneidad (I²); dada la variabilidad, se aplicó un modelo de efectos aleatorios y análisis de sensibilidad; la calidad se valoró a través de la metodología de Jadad.
Resultados: En la búsqueda se identificaron 120 artículos; 50 pasaron a texto completo; se incluyeron 45 en el análisis cuantitativo. Los factores con mayor asociación con RA fueron: estancia en UCI >10 días (OR 2,90; IC95% 2,10–4,00; I² 71%), uso prolongado de antibióticos (OR 2,45; IC95% 1,80–3,30; I² 67%), catéter venoso central (OR 2,10; IC95% 1,60–2,80; I² 40%) y ventilación mecánica (OR 1,95; IC95% 1,40–2,70; I² 52%). Se reportaron con alta frecuencia Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii y Escherichia coli.
Conclusiones: La resistencia antimicrobiana en UCI es multifactorial y se relaciona con exposición a dispositivos invasivos, uso inadecuado/prolongado de antibióticos y estancias prolongadas. Programas de optimización de antimicrobianos, vigilancia y control de infecciones disminuyen el riesgo; el fortalecimiento organizacional y del equipo de enfermería es clave.
Palabras clave
resistencia a los antibióticos factores predisponentes microorganismos multirresistentes estancia prolongada medidas de prevención
Abstract
Objective: To analyze the factors associated with antibiotic resistance (AR) in critically ill adult patients admitted to the Intensive Care Unit (ICU) through a systematic review and meta-analysis.
Methods: The methodology followed the PRISMA guidelines. Studies published during the last 10 years in English and Spanish were searched in PubMed, Scopus, Web of Science, SciELO, LILACS, and CINAHL using MeSH and DeCS descriptors. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were extracted, and heterogeneity was assessed using the I² statistic. Given the variability among studies, a random-effects model and sensitivity analysis were applied. Methodological quality was assessed using the Jadad methodology.
Results: A total of 120 articles were identified, 50 were assessed in full text, and 45 were included in the quantitative analysis. The factors most strongly associated with antibiotic resistance were ICU stay >10 days (OR 2.90; 95% CI 2.10–4.00; I² 71%), prolonged antibiotic use (OR 2.45; 95% CI 1.80–3.30; I² 67%), central venous catheter use (OR 2.10; 95% CI 1.60–2.80; I² 40%), and mechanical ventilation (OR 1.95; 95% CI 1.40–2.70; I² 52%). The most frequently reported microorganisms were Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Escherichia coli.
Conclusions: Antimicrobial resistance in the ICU is multifactorial and is associated with exposure to invasive devices, inappropriate or prolonged antibiotic use, and prolonged ICU stay. Antimicrobial stewardship programs, surveillance, and infection prevention and control measures reduce the risk, while strengthening organizational strategies and the nursing workforce is essential.
Methods: The methodology followed the PRISMA guidelines. Studies published during the last 10 years in English and Spanish were searched in PubMed, Scopus, Web of Science, SciELO, LILACS, and CINAHL using MeSH and DeCS descriptors. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were extracted, and heterogeneity was assessed using the I² statistic. Given the variability among studies, a random-effects model and sensitivity analysis were applied. Methodological quality was assessed using the Jadad methodology.
Results: A total of 120 articles were identified, 50 were assessed in full text, and 45 were included in the quantitative analysis. The factors most strongly associated with antibiotic resistance were ICU stay >10 days (OR 2.90; 95% CI 2.10–4.00; I² 71%), prolonged antibiotic use (OR 2.45; 95% CI 1.80–3.30; I² 67%), central venous catheter use (OR 2.10; 95% CI 1.60–2.80; I² 40%), and mechanical ventilation (OR 1.95; 95% CI 1.40–2.70; I² 52%). The most frequently reported microorganisms were Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Escherichia coli.
Conclusions: Antimicrobial resistance in the ICU is multifactorial and is associated with exposure to invasive devices, inappropriate or prolonged antibiotic use, and prolonged ICU stay. Antimicrobial stewardship programs, surveillance, and infection prevention and control measures reduce the risk, while strengthening organizational strategies and the nursing workforce is essential.
Keywords
antibiotic resistance predisposing factors multidrug-resistant microorganisms prolonged stay preventive measures