Department of Medical Education and General Practice, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan.
Department of Bacteriology, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan; Research Centre for Infectious Disease Sciences, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan.
Int J Antimicrob Agents. 2023 May;61(5):106767. doi: 10.1016/j.ijantimicag.2023.106767. Epub 2023 Feb 28.
Klebsiella pneumoniae strains pose a significant threat to public health. Currently, it is inconclusive whether hypermucoviscous K. pneumoniae (hmKp; semi-quantitatively defined by a positive 'string test') bacteraemia is clinically more severe than non-hmKp bacteraemia. Hence, this systematic review and meta-analysis was conducted with the aim of drawing some conclusions on hypermucoviscosity and bacteraemia.
PubMed and Web of Science databases were searched for all relevant publications from January 2000 to March 2022. The outcome measures were mortality rate and abscess formation.
Fourteen observational studies were included in this systematic review, comprising a total of 3092 patients with K. pneumoniae bacteraemia, including 746 (24.1%) patients with hmKp strains. The meta-analysis showed that hmKp bacteraemia did not account for a significant increase in the incidence of all-cause mortality compared with non-hmKp bacteraemia [pooled hazard ratio 1.30, 95% confidence interval (CI) 0.79-2.12; P=0.30]. However, hmKp bacteraemia was associated with a significant increase in the incidence of abscess formation compared with non-hmKp bacteraemia (pooled odds ratio 7.74, 95% CI 4.96-12.06; P<0.00001).
Although mortality may not be dependent on the causative agent, this review reaffirms the importance of the string test to detect hmKp. There is a need for prudent management, especially for patients with hmKp, that should include investigations for liver abscess and/or metastatic spread, and measures for early and proper source control as this can improve the prognosis.
肺炎克雷伯菌菌株对公共健康构成重大威胁。目前，高黏液型肺炎克雷伯菌（hmKp；通过“拉丝试验”半定量定义）菌血症是否比非 hmKp 菌血症在临床上更严重尚无定论。因此，进行了这项系统评价和荟萃分析，旨在对高黏液性和菌血症得出一些结论。
检索了 2000 年 1 月至 2022 年 3 月期间所有相关文献的 PubMed 和 Web of Science 数据库。结局指标为死亡率和脓肿形成。
本系统评价纳入了 14 项观察性研究，共纳入 3092 例肺炎克雷伯菌菌血症患者，其中 746 例（24.1%）为 hmKp 菌株。荟萃分析显示，与非 hmKp 菌血症相比，hmKp 菌血症并不导致全因死亡率显著增加[合并危险比 1.30，95%置信区间（CI）0.79-2.12；P=0.30]。然而，与非 hmKp 菌血症相比，hmKp 菌血症与脓肿形成的发生率显著增加相关[合并优势比 7.74，95%CI 4.96-12.06；P<0.00001]。
尽管死亡率可能不取决于病原体，但本综述再次证实了拉丝试验检测 hmKp 的重要性。需要谨慎管理，特别是对于 hmKp 患者，应包括肝脓肿和/或转移性播散的检查，以及早期和适当的源头控制措施，这可以改善预后。
