Wei Wei, Lian Yueran, Peng Yao, Kan Biao, Li Zhenpeng, Lu Xin
National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; School of Public Health, Shandong University, Jinan, China.
Int J Antimicrob Agents. 2025 Aug;66(2):107520. doi: 10.1016/j.ijantimicag.2025.107520. Epub 2025 Apr 20.
Monitoring the drug resistance phenotypes of Klebsiella pneumoniae is crucial in clinical practice. This study aims to evaluate the prevalence of drug resistance of clinical K. pneumoniae isolates in China over the past two decades using a systematic review and meta-analysis.
We systematically searched five databases for relevant articles published between January 1, 2003 and November 21, 2023. We assessed the resistance of clinical K. pneumoniae strains isolated in China over the past 20 years to 15 antibiotics, which were divided into three subgroups.
A total of 177 studies derived from 160 articles were eligible for meta-analysis. The pooled antibiotic resistance rate ranged from 5.01% (for imipenem) to 96.03% (for ampicillin). The pooled rate of resistance to the carbapenem antibiotics imipenem and meropenem was relatively low, and subgroup analyses showed that these rates increased over time. The antibiotic resistance rate showed a geographic trend, being highest in central China and lowest in northwest China. The drug resistance rate was highest in strains isolated from specimens from patients with urinary tract infections.
This meta-analysis provides reliable data on the rate of antibiotic resistance of K. pneumoniae grouped according to isolation region, time, and source, which may be helpful for the selection of antibiotics for clinical treatment. Areas requiring specific attention include management of the use of carbapenem, improving the prevention and treatment of K. pneumoniae in patients with urinary tract infections, and control of transmission of strains from one region to another.
监测肺炎克雷伯菌的耐药表型在临床实践中至关重要。本研究旨在通过系统评价和荟萃分析评估过去二十年中国临床分离的肺炎克雷伯菌的耐药率。
我们系统检索了五个数据库，以查找2003年1月1日至2023年11月21日期间发表的相关文章。我们评估了过去20年在中国分离的临床肺炎克雷伯菌菌株对15种抗生素的耐药情况，这些抗生素分为三个亚组。
共有来自160篇文章的177项研究符合荟萃分析的条件。汇总的抗生素耐药率范围从5.01%（亚胺培南）到96.03%（氨苄西林）。对碳青霉烯类抗生素亚胺培南和美罗培南的汇总耐药率相对较低，亚组分析表明这些耐药率随时间增加。抗生素耐药率呈现出地理趋势，在中国中部最高，在西北部最低。从尿路感染患者标本中分离的菌株的耐药率最高。
这项荟萃分析提供了按分离地区、时间和来源分组的肺炎克雷伯菌抗生素耐药率的可靠数据，这可能有助于临床治疗中抗生素的选择。需要特别关注的领域包括碳青霉烯类药物使用的管理、改善尿路感染患者肺炎克雷伯菌的预防和治疗以及控制菌株在不同地区之间的传播。
