Shifting the research paradigm to tackle antimicrobial resistance: An integrated biomedical and non-biomedical disciplinary collaboration

This umbrella review evaluated the risk of infection after colonization with multidrug-resistant Gram-negative bacteria (MDR-GNB), focusing mainly on ESBL-producing and carbapenem-resistant Enterobacterales (ESBL-E and CRE). Seventeen systematic reviews and meta-analyses were included, with quality assessed using the AMSTAR 2 tool. The pooled incidence of infection after colonization was about 22% for both ESBL-E and CRE. Evidence on mortality, transmission, MDR Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii was limited. The findings highlight a substantial infection risk that may guide patient counseling, innovation in decolonization strategies, clinical trial design, and regulatory approvals, though population heterogeneity limits broad applicability.