Treatment of resistant Pseudomonas aeruginosa infection continues to be a challenge in Latin American countries (LATAM). We synthesize the literature on the use of appropriate initial antibiotic therapy (AIAT) and inappropriate initial antibiotic therapy (IIAT) in P. aeruginosa infections, and the literature on risk factors for acquisition of resistant P. aeruginosa among hospitalized adult patients in LATAM. MEDLINE, EMBASE, Cochrane, and LILAC were searched between 2000 and August 2019. Abstracts and full-text articles were screened in duplicate. Random effects meta-analysis was conducted when studies were sufficiently similar. The screening of 165 citations identified through literature search yielded 98 full-text articles that were retrieved and assessed for eligibility, and 19 articles conducted in Brazil (14 articles), Colombia (4 articles), and Cuba (1 article) met the inclusion criteria. Of 19 eligible articles, six articles (840 subjects) examined AIAT compared to IIAT in P. aeruginosa infections; 17 articles (3203 total subjects) examined risk factors for acquisition of resistant P. aeruginosa; and four articles evaluated both. Four of 19 articles were rated low risk of bias and the remaining were deemed unclear or high risk of bias. In meta-analysis, AIAT was associated with lower mortality for P. aeruginosa infections (unadjusted summary OR 0.48, 95% CI 0.28–0.81; I2 = 59%), compared to IIAT and the association with mortality persisted in subgroup meta-analysis by low risk of bias (3 articles; unadjusted summary OR 0.46, 95% CI 0.28–0.81; I2 = 0%). No meta-analysis was performed for studies evaluating risk factors for acquisition of resistant P. aeruginosa as they were not sufficiently similar. Significant risk factors for acquisition of resistant P. aeruginosa included: prior use of antibiotics (11 articles), stay in the intensive care unit (ICU) (3 articles), and comorbidity score (3 articles). Outcomes were graded to be of low strength of evidence owing to unclear or high risk of bias and imprecise estimates. Our study highlights the association of AIAT with lower mortality and prior use of antibiotics significantly predicts acquiring resistant P. aeruginosa infections. This review reinforces the need for rigorous and structured antimicrobial stewardship programs in the LATAM region.

中文翻译：

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拉丁美洲住院成年人中的假单胞菌感染：系统评价和荟萃分析。

在拉丁美洲国家（LATAM），抗药性铜绿假单胞菌感染的治疗仍然是一个挑战。我们综合了在铜绿假单胞菌感染中使用适当的初始抗生素治疗（AIAT）和不适当的初始抗生素治疗（IIAT）的文献，以及在LATAM住院的成年患者中获得耐药铜绿假单胞菌危险因素的文献。在2000年至2019年8月之间搜索了MEDLINE，EMBASE，Cochrane和LILAC。一式两份地筛选了摘要和全文。当研究足够相似时，进行随机效应荟萃分析。对通过文献检索确定的165条引文进行筛选，得出了98篇全文文章，并对其进行了资格评估，并在巴西（14篇文章），哥伦比亚（4篇文章），古巴（1条）符合纳入标准。在19篇合格文章中，有6篇文章（840名受试者）对铜绿假单胞菌感染的AIAT与IIAT进行了比较。17篇文章（共3203名受试者）检查了获得耐药铜绿假单胞菌的危险因素；和四篇文章都进行了评估。19篇文章中有4篇被评为低偏见风险，其余文章被视为不清楚或偏高风险。在荟萃分析中，与IIAT相比，AIAT与铜绿假单胞菌感染的死亡率较低（摘要未作调整或0.48，95％CI 0.28–0.81； I2 = 59％），并且与死亡率的相关性在亚组荟萃分析中持续存在低偏见风险（3篇文章；未经调整的摘要或0.46，95％CI 0.28–0.81； I2 = 0％）。对于评估获得耐药性P的危险因素的研究未进行荟萃分析。铜绿假单胞菌，因为它们不够相似。获得耐药性铜绿假单胞菌的重要危险因素包括：事先使用抗生素（11条），留在重症监护病房（ICU）（3条）和合并症评分（3条）。由于偏倚和估计不准确的风险较高或较高，因此将结果分级为证据强度低。我们的研究突出了AIAT与较低死亡率的关联，并且先前使用抗生素可显着预测获得耐药的铜绿假单胞菌感染。这次审查加强了对拉美地区严格而结构化的抗菌素管理计划的需求。和合并症评分（3篇文章）。由于偏倚和估计不准确的风险较高或较高，因此将结果分级为证据强度低。我们的研究突出了AIAT与较低死亡率的关联，并且先前使用抗生素可显着预测获得耐药的铜绿假单胞菌感染。这次审查加强了对拉美地区严格而结构化的抗菌素管理计划的需求。和合并症评分（3篇文章）。由于偏倚和估计不准确的风险较高或较高，因此将结果分级为证据强度低。我们的研究突出了AIAT与较低死亡率的关联，并且先前使用抗生素可显着预测获得耐药的铜绿假单胞菌感染。这次审查加强了对拉美地区严格而结构化的抗菌素管理计划的需求。