Antimicrobial resistance in hypermucoviscous and non-hypermucoviscous : a systematic review and meta-analysis.

Antimicrobial resistance has recently increased due to emerging carbapenem-resistant and extended-spectrum β-lactamase (ESBL)-producing strains of , especially among hypermucoviscous (hmKp) strains. To evaluate the prevalence of ESBL-producing and carbapenem-resistant strains in hmKp and non-hmKp clinical isolates through a systematic review and meta-analysis. We searched PubMed, Scopus, and Cochrane Library databases from January 2000 to June 2023. Clinical and in vivo/in vitro studies involving confirmed clinical isolates differentiated into hmKP and non-hmKP strains based on string test results. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated based on the number of individuals in each target group. Forest plots were used to visualize the effect sizes and 95% CIs of individual studies estimated using the inverse variance and DerSimonian - Laird methods with fixed - and random-effects models, respectively. Heterogeneity was assessed using Cochran's Q test ( ≥ 50%). Fifteen studies comprising 2049 clinical isolates of met the inclusion criteria. Meta-analysis revealed that hmKp strains were associated with a significantly lower prevalence of ESBL-producing strains (pooled OR: 0.26, 95% CI: 0.11-0.63,  = 0.003) and a slightly lower prevalence of carbapenem-resistant strains than non-hmKp strains (pooled OR: 0.63, 95% CI: 0.40-0.97,  = 0.038). hmKp strains exhibited lower and slightly lower prevalence of ESBL production and carbapenem resistance, respectively, than non-hmKp strains. However, given the rising prevalence of ESBL-producing and carbapenem-resistant hmKp strains, patients infected by string-test-positive must be managed prudently, considering the potential for highly resistant strains.