A Systematic Review and Meta- Analyses Show that Carbapenem Use and Medical Devices Are the Leading Risk Factors for CarbapenemResistant Pseudomonas aeruginosa

A systematic review and meta-analyses were performed to identify the risk factors associated with carbapenem-resistant Pseudomonas aeruginosa and to identify sources and reservoirs for the pathogen. A systematic search of PubMed and Embase databases from 1 January 1987 until 27 January 2012 identified 1,662 articles, 53 of which were included in a systematic review and 38 in a random-effects meta-analysis study. The use of carbapenem, use of fluoroquinolones, use of vancomycin, use of other antibiotics, having medical devices, intensive care unit ( ICU) admission, having underlying diseases, patient characteristics, and length of hospital stay were significant risk factors in multivariate analyses. The meta- analyses showed that carbapenem use ( odds ratio [ OR] = 7.09; 95% confidence interval [ CI] = 5.43 to 9.25) and medical devices ( OR=5.11; 95% CI =3.55 to 7.37) generated the highest pooled estimates. Cumulative meta- analyses showed that the pooled estimate of carbapenem use was stable and that the pooled estimate of the risk factor " having medical devices" increased with time. We conclude that our results highlight the importance of antibiotic stewardship and the thoughtful use of medical devices in helping prevent outbreaks of carbapenem-resistant P. aeruginosa.