Affiliation:
1. Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine , Hangzhou , China
2. Department of FSTC Clinic, The First Affiliated Hospital, Zhejiang University School of Medicine , Hangzhou , China
Abstract
Abstract
Background
Due to scarce therapeutic options, hospital-acquired infections caused by Klebsiella pneumoniae (KP), particularly carbapenem-resistant KP (CRKP), pose enormous threat to patients’ health worldwide. This study aimed to characterize the epidemiology and risk factors of CRKP among nosocomial KP infections.
Method
MEDLINE, Embase, PubMed, and Google Scholar were searched for studies reporting CRKP prevalence from inception to 30 March 2023. Data from eligible publications were extracted and subjected to meta-analysis to obtain global, regional, and country-specific estimates. To determine the cause of heterogeneity among the selected studies, prespecified subgroup analyses and meta-regression were also performed. Odds ratios of CRKP-associated risk factors were pooled by a DerSimonian and Laird random-effects method.
Results
We retained 61 articles across 14 countries and territories. The global prevalence of CRKP among patients with KP infections was 28.69% (95% CI, 26.53%–30.86%). South Asia had the highest CRKP prevalence at 66.04% (95% CI, 54.22%–77.85%), while high-income North America had the lowest prevalence at 14.29% (95% CI, 6.50%–22.0%). In the country/territory level, Greece had the highest prevalence at 70.61% (95% CI, 56.77%–84.45%), followed by India at 67.62% (95% CI, 53.74%–81.79%) and Taiwan at 67.54% (95% CI, 58.65%–76.14%). Hospital-acquired CRKP infections were associated with the following factors: hematologic malignancies, corticosteroid therapies, intensive care unit stays, mechanical ventilations, central venous catheter implantations, previous hospitalization, and antibiotic-related exposures (antifungals, carbapenems, quinolones, and cephalosporins).
Conclusions
Study findings highlight the importance of routine surveillance to control carbapenem resistance and suggest that patients with nosocomial KP infection have a very high prevalence of CRKP.
Funder
National Natural Science Foundation of China
China Postdoctoral Science Foundation
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Oncology