Evidence map›Paper›PMID 31964661›Full record

SynthesisBMJ open2020

Variation of effect estimates in the analysis of mortality and length of hospital stay in patients with infections caused by bacteria-producing extended-spectrum beta-lactamases: a systematic review and meta-analysis.

Parichehr Shamsrizi, Beryl Primrose Gladstone, Elena Carrara, Dora Luise, Andrea Cona, Chiara Bovo, Evelina Tacconelli

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 16 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
51citing papers in PubMed, 16 pooled it
3.1field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

51 citing papers in PubMed, 16 syntheses or guidelines pooled it, 89 citations in OpenAlex.

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  13. SurgicalRenal failure · 2022
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  16. Antibiotic use in Brazilian hospitals in the 21st century: a systematic review.Revista da Sociedade Brasileira de Medicina Tropical · 2021
    Pooled it
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  19. Renal safety of amikacin compared with ceftriaxone in patients treated for urinary tract infection: an observational cohort study.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 2 countries.

Parichehr ShamsriziDivision of Infectious Disease, Department of Internal Medicine I Gastroenterology Hepatology and Infectious Diseases, University Hospital Tubingen, Tubingen, Germany.ORCID 0000-0002-0376-0967
Beryl Primrose GladstoneDivision of Infectious Disease, Department of Internal Medicine I Gastroenterology Hepatology and Infectious Diseases, University Hospital Tubingen, Tubingen, Germany.
Elena CarraraDivision of Infectious Disease, Department of Internal Medicine I Gastroenterology Hepatology and Infectious Diseases, University Hospital Tubingen, Tubingen, Germany elena.carrara@univr.it.
Dora LuiseDivision of Infectious Disease, Department of Diagnostic and Public Health, Integrated University Hospital of Verona, Verona, Italy.
Andrea ConaClinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, Milano, Italy.
Chiara BovoMedical Direction, Integrated University Hospital of Verona, Verona, Italy.
Evelina TacconelliDivision of Infectious Disease, Department of Internal Medicine I Gastroenterology Hepatology and Infectious Diseases, University Hospital Tubingen, Tubingen, Germany.
University of Verona · ITUniversity Children's Hospital Tübingen · DEOspedale San Paolo · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess the variation of effect estimates in the analysis of mortality and length of stay (LOS) in patients with infections caused by extended-spectrum beta-lactamase (ESBL)-producing

designSystematic review and meta-analysis

methodsLiterature search for clinical studies from 1 January 1960 to 1 October 2018 was conducted in PubMed. Primary outcomes were risk ratios (RRs) of all-cause and attributable mortality and weighted mean differences (WMDs) in LOS in patients with bloodstream infections (BSIs) and non-invasive infections. Any change in the effect estimates was assessed by grouping studies according to design, setting, economy-based country classification, reporting period, microbiological aetiology, infection type and adjustment for appropriateness of empirical treatment. The impact of ESBL production was calculated using random-effect meta-analysis and heterogeneity was evaluated by I

resultsEighty-four studies including 22 030 patients and 149 outcome measures were included in the meta-analysis. Most studies were retrospective cohorts from high-income countries, providing unadjusted estimates. ESBL production in patients with BSIs (56 studies) increased the RR for all-cause mortality by a factor of 1.70 (95% CI 1.52 to 1.90; p<0.001), attributable mortality (16 studies) by 1.75 (95% CI 1.448 to 2.108; p<0.001) and WMD in the intensive care unit by 3.07 days (95% CI 1.61 to 4.54; p<0.001). WMD in hospital LOS was significantly higher in BSIs (4.41 days; 95% CI 3.37 to 5.46; p<0.001) and non-invasive (2.19 days; 95% CI 1.56 to 2.81; p<0.001). Subgroup analyses showed variation of estimates by study design, population, strain and assessment of appropriateness of empiric treatment. High heterogeneity was observed in all analyses.

conclusionsCurrent evidence of the clinical burden of infections caused by ESBL-producing bacteria is highly heterogeneous and based mainly on unadjusted estimates derived from retrospective studies. Despite these limitations, ESBL production in strains causing BSIs seems associated with higher all-cause and attributable mortality and longer hospitalisation.

Indexed as

beta-LactamasesCross InfectionEnterobacteriaceaeEnterobacteriaceae InfectionsHumansLength of Staybeta-Lactamasesbloodstream infectionextended-spectrum beta-lactamaselength of staymeta-analysismortalitysystematic review

Identifiers

PMID31964661
PMCPMC7044956
OpenAlexW3001487635

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.