Relationship between antibiotic exposure and carbapenem-resistant Klebsiella pneumoniae infection within four types of control patients: A systematic review and meta-analysis

Abstract

This study attempted to identify the relationship between antibiotic exposure and carbapenem-resistant Klebsiella pneumoniae (CRKP) infection. Antibiotic exposure were chosen as the risk factors for CRKP infection, which were extracted from research articles indexed in PubMed, EMBASE and Cochrane Library. Relevant studies published until January 2023 were reviewed, and a meta-analysis was conducted on antibiotic exposure within the four types of control groups, which comprised of 52 studies. The meta-analysis was performed within four types of control groups: patients infected with carbapenem-susceptible Klebsiella pneumoniae (comparison 1), other infection especially without CRKP infection (comparison 2), CRKP colonization (comparison 3) and no infection (comparison 4). The two risk factors were common to the four comparisons according to Carbapenem and Aminoglycoside exposure. Compared to Carbapenem-susceptible Klebsiella pneumoniae (CSKP) infection, Tegacyclin exposure in bloodstream infection and Quinolone exposure within 30 days were associated with increased risk for CRKP infection. However, Tegacyclin exposure in MIX infection (MIX infection included two or more different infection sites) and Quinolone exposure within 90 days possessed a similar risk for both CRKP and CSKP infection. Carbapenem and Aminoglycoside exposure serve as likely risk factors for CRKP infection. Meanwhile, antibiotic exposure time as continuous variables was not relatedtoCRKP infection compared to CSKP infection. Tigecycline exposure in MIX infection and Quinolone exposure within 90 days may not increase the risk of CRKP infection.