Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae.
Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae.
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DOI：
10.1186/s12941-017-0191-3
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发表时间：
2017-03-29
影响因子：
5.7
通讯作者：
Ma X
中科院分区：
文献类型：
--
作者：
Xu L;Sun X;Ma X
碳青霉烯类抗生素抗性K.肺炎克雷伯氏菌（CRKP）由于其非常有限的治疗选择而引起广泛关注，并且该菌株近年来迅速增加。虽然一般认为耐药性与死亡率增加有关，但其他一些研究发现没有这种关系。为了估计一般CRKP感染患者的死亡率并分析这种感染的死亡率因素，因此，我们进行了这项系统综述和荟萃分析。对截至2015年12月发表的相关研究进行了系统性文献综述。我们选择并评估了报告CRKP感染患者死亡率的文章。2462例CRKP感染患者的合并死亡率为42.14%，而感染碳青霉烯类敏感K的患者的合并死亡率为21.16%。肺炎（CSKP）。血液感染（BSI）或尿路感染患者的死亡率分别为54.30%和13.52%，入住重症监护室（ICU）或接受实体器官移植（SOT）的患者的死亡率分别为48.9%和43.13%。感染克雷伯氏菌的病人病死率为47.66%。产碳青霉烯酶肺炎克雷伯氏菌产VIM肺炎克雷伯氏菌感染者占46.71%;肺炎。从地理位置来看，北美、南美、欧洲和亚洲研究报告的死亡率分别为33.24%、46.71%、50.06%和44.82%。我们的研究表明，CRKP感染患者的死亡率高于CSKP感染患者，尤其是与BSI、ICU入院或SOT相关的患者。我们还认为患者的生存与其身体状况有密切关系。我们的研究结果表明，应重视CRKP感染，并需要严格的感染控制措施和新的抗生素来防止CRKP感染。
Carbapenem resistant K. pneumoniae (CRKP) has aroused widespread attention owing to its very limited therapeutic options, and this strain has increased rapidly in recent years. Although it is accepted that drug resistance is associated with increased mortality in general, but some other studies found no such relationship. To estimate mortality of patients infected with CRKP in general and analyze factors for mortality of this infection, thus, we conducted this systematic review and meta-analysis. A systematic literature review of relevant studies published until December 2015 was conducted. We selected and assessed articles reporting mortality of patients infected with CRKP. Pooled mortality was 42.14% among 2462 patients infected with CRKP versus 21.16% in those infected with carbapenem-susceptible K. pneumoniae (CSKP). The mortality of patients with bloodstream infection (BSI) or urinary tract infection was 54.30 and 13.52%, respectively, and 48.9 and 43.13% in patients admitted to the intensive care unit (ICU) or who underwent solid organ transplantation (SOT). Mortality was 47.66% in patients infected with K. pneumoniae carbapenemase-producing K. pneumoniae and 46.71% in those infected with VIM-producing K. pneumoniae. Geographically, mortality reported in studies from North America, South America, Europe, and Asia was 33.24, 46.71, 50.06, and 44.82%, respectively. Our study suggests that patients infected with CRKP have higher mortality than those infected with CSKP, especially in association with BSI, ICU admission, or SOT. We also considered that patients’ survival has a close relationship with their physical condition. Our results imply that attention should be paid to CRKP infection, and that strict infection control measures and new antibiotics are required to protect against CRKP infection.