OBJECTIVES : Carbapenem-resistance Enterobacteriaceae (CRE) are considered a critical public health problem, characterized by being difficult-to-treat and high levels of multi-drug resistance. This has led to negative clinical outcomes and higher healthcare costs. This study aims to understand the existing evidence of the burden of CRE infections in Asia.

METHODS : A systematic literature review (SLR) and meta-analysis of randomized controlled trials and observational studies published in the last 10 years were conducted following Cochrane and PRISMA guidelines. Evidence-Based Medicine Reviews, EMBASE and Medline were searched on October 14, 2019. Studies were evaluated for comparability and only those with comparable baseline characteristics were included. The metafor package in R was used to conduct the meta-analysis. Pooled results for adult hospital length of stay (LOS) (6 studies) and all-cause mortality (8 studies) are reported here.

RESULTS : Overall, there was limited published data reporting on CRE burden in Asia. Hospital LOS ranged from 19 to 54 days, 42 days (China; 3 studies), 36 days (Malaysia; 1 study), 23 days (Taiwan, 1 study) and 19 days (India, 1 study). The pooled mean hospital LOS was 34 days. The mean difference in LOS was higher for CRE patients compared to non-CRE patients by 9.51 days (p<.0001), based on 3 studies. Hospital mortality among CRE patients ranged from 35% to 46%. The pooled all-cause mortality was 40% using all studies. Comparing CRE to non-CRE patients, mortality risk was 3.67 times (p<.0001) greater for CRE patients.

CONCLUSIONS : Pooled risk estimates from this meta-analysis revealed that CRE infections were associated with longer hospitalization and an increased mortality risk. Our analysis highlights the importance of targeted infection prevention, control programs and antimicrobial stewardship activities to contain CRE in Asia.