Abstract
BackgroundStudies on risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) infection have provided inconsistent results, partly due to the choice of the control group. We conducted a systematic review and meta-analysis to assess the risk factors for CRKP infection by comparing CRKP-infected patients with two types of controls: patients infected with carbapenem-susceptible Klebsiella pneumoniae (comparison 1) or patients not infected with CRKP (comparison 2).MethodsData on potentially relevant risk factors for CRKP infection were extracted from studies indexed in PubMed, EMBASE, Web of Science or EBSCO databases from January 1996 to April 2019, and meta-analyzed based on the outcomes for each type of comparison.ResultsThe meta-analysis included 18 studies for comparison 1 and 14 studies for comparison 2. The following eight risk factors were common to both comparisons: admission to intensive care unit (ICU; odds ratio, ORcomparison 1 = 3.20, ORcomparison 2 = 4.44), central venous catheter use (2.62, 3.85), mechanical ventilation (2.70, 4.78), tracheostomy (2.11, 8.48), urinary catheter use (1.99, 0.27), prior use of antibiotic (6.07, 1.61), exposure to carbapenems (4.16, 3.84) and exposure to aminoglycosides (1.85, 1.80). Another 10 risk factors were unique to comparison 1: longer length of hospital stay (OR = 15.28); prior hospitalization (within the previous 6 months) (OR = 1.91); renal dysfunction (OR = 2.17); neurological disorders (OR = 1.52); nasogastric tube use (OR = 2.62); dialysis (OR = 3.56); and exposure to quinolones (OR = 2.11), fluoroquinolones (OR = 2.03), glycopeptides (OR = 3.70) and vancomycin (OR = 2.82).ConclusionsEighteen factors may increase the risk of carbapenem resistance in K. pneumoniae infection; eight factors may be associated with both K. pneumoniae infections in general and CRKP in particular. The eight shared factors are likely to be ‘true’ risk factors for CRKP infection. Evaluation of risk factors in different situations may be helpful for empirical treatment and prevention of CRKP infections.
Highlights
Studies on risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) infection have provided inconsistent results, partly due to the choice of the control group
The inclusion criterion (3) led us to exclude studies comparing patients infected with carbapenemase-producing K. pneumoniae (CPKP) with controls without such infection, since such controls may have been infected with carbapenem-resistant, noncarbapenemase-producing K. pneumoniae
18 studies performing comparison 1 [17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34] and 14 for comparison 2 [35,36,37,38,39,40,41,42,43,44,45,46,47,48] were included in the systematic review, while subsets of these studies were included in the meta-analyses of the various risk factors (Fig. 1)
Summary
Studies on risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) infection have provided inconsistent results, partly due to the choice of the control group. We conducted a systematic review and metaanalysis to assess the risk factors for CRKP infection by comparing CRKP-infected patients with two types of controls: patients infected with carbapenem-susceptible Klebsiella pneumoniae (comparison 1) or patients not infected with CRKP (comparison 2). The most important genes that can confer carbapenem resistance (via carbapenemases) are present in K. pneumoniae, rendering almost all available treatment options ineffective [2]. Mortality rates reach 33–50% among CRKP-infected patients in different regions of the world [5], significantly higher than mortality caused by infection with carbapenem-susceptible K. pneumoniae (CSKP) [1]. Preventing CRKP infection is important to avoid poor prognosis and even death, and to prevent widespread transmission of carbapenem resistance through mobile genetic elements [6, 7]
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