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Systematic literature review of the burden and outcomes of infections due to multidrug-resistant organisms in Europe: the ABOUT-MDRO project protocol

Blanca Anaya-Baz, Natalia Maldonado, Zaira R  Palacios-Baena, Virginia Palomo, Maria Diletta Pezzani, Sheila Chiesi,  Elisa Razzaboni, Monica Compri, Evelina Tacconelli, Jesús  Rodriguez-Baño.

BMJ Open . 2020 May 5;10(5):e030608. doi: 10.1136/bmjopen-2019-030608, 05/2020.

Introduction: Despite  the increasing importance of infections due to multidrug-resistant  organisms (MDROs), there is a lack of comprehensive information about  the burden of disease and outcomes of key infections caused by these  pathogens. The aim of the ABOUT-MDRO (A systematic review on the burden  and outcomes of infections due to multidrug resitant organisms) project  is to provide estimations of the burden of some key infections and their  outcomes caused by the target MDROs.

Methods and analysis: A  systematic literature search will be performed using MEDLINE/PubMed,  Elsevier's SCOPUS, Cochrane library, Clinical trials and Web of Science,  as well as the Surveillance Systems from Public Health Institutions and  Scientific Societies for Antimicrobial Resistance and  Healthcare-Associated Infections in Europe database of European  surveillance systems, for data on prevalence/incidence, mortality and  length of stay of target infections in hospitalised patients (including  ventilator-associated pneumonia, hospital-acquired pneumonia,  complicated intra-abdominal infections, complicated urinary tract  infections, skin and soft tissue infections and bloodstream infections)  and in specific populations (children, hospital wards, neutropenic  patients) caused by cephalosporin-resistant or carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter spp., methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococcus spp.  The information retrieved will be tabulated and pooled estimates and  95% CIs calculated of rates and outcomes, using random effects models.  Relationships between rates and outcomes in randomised control trials  and epidemiological studies, and data of proportions and  incidence/prevalence rates will also be analysed. The information  collected in this study will be useful for identifying gaps in our  knowledge in terms of incidence/prevalence and clinical outcomes of  infections caused by MDROs, and for informing priorities in infection  control and the research and design of appropriate studies.

Ethics and dissemination: This  study will be based on published data so we did not require ethical  approval. Formal consent is not required. The results of this review  will be reported according to the Preferred Reporting Items for  Systematic Review and Meta-Analyses statement. Data will be presented at  international conferences and published in peer-reviewed journals.

Registration details: PROSPERO ( (CRD42019124185).

Keywords: antimicrobial resistance; healthcare-associated infections; incidence rates; outcome; surveillance.

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