Division of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, No. 1 You Yi Road, Yuan Jia Gang, Yuzhong District, Chongqing, 400016, China.
Department of Hospital Infection Control, The First Affiliated Hospital of Chongqing Medical University, No. 1 You Yi Road, Yuan Jia Gang, Yuzhong District, Chongqing, 400016, China.
Antimicrob Resist Infect Control. 2020 Jan 31;9(1):23. doi: 10.1186/s13756-020-0686-0.
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 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).
Data 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.
The 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, OR = 3.20, OR = 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).
Eighteen 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.
关于碳青霉烯类耐药肺炎克雷伯菌（CRKP）感染危险因素的研究结果并不一致，部分原因是对照组的选择。我们进行了系统评价和荟萃分析，通过将 CRKP 感染患者与两种类型的对照组进行比较（比较 1：感染碳青霉烯类敏感肺炎克雷伯菌的患者；比较 2：未感染 CRKP 的患者），来评估 CRKP 感染的危险因素。
从 1996 年 1 月至 2019 年 4 月在 PubMed、EMBASE、Web of Science 或 EBSCO 数据库中检索可能与 CRKP 感染相关的潜在危险因素数据，并根据每种比较的结果进行荟萃分析。
荟萃分析纳入了比较 1 的 18 项研究和比较 2 的 14 项研究。以下 8 个危险因素在两种比较中均存在：入住重症监护病房（ICU；比值比，OR=3.20，OR=4.44）、中心静脉导管使用（2.62，3.85）、机械通气（2.70，4.78）、气管切开术（2.11，8.48）、导尿（1.99，0.27）、既往使用抗生素（6.07，1.61）、接触碳青霉烯类（4.16，3.84）和接触氨基糖苷类（1.85，1.80）。另 10 个危险因素仅在比较 1 中存在：住院时间较长（OR=15.28）；既往住院（6 个月内）（OR=1.91）；肾功能不全（OR=2.17）；神经系统疾病（OR=1.52）；鼻胃管使用（OR=2.62）；透析（OR=3.56）；接触喹诺酮类（OR=2.11）、氟喹诺酮类（OR=2.03）、糖肽类（OR=3.70）和万古霉素（OR=2.82）。
18 个因素可能增加肺炎克雷伯菌感染碳青霉烯类耐药的风险；8 个因素可能与肺炎克雷伯菌感染特别是 CRKP 感染有关。这 8 个共同的因素可能是 CRKP 感染的“真正”危险因素。在不同情况下评估危险因素可能有助于经验性治疗和预防 CRKP 感染。
