Relationship between antibiotic exposure and carbapenem-resistant Klebsiella pneumoniae infection within four types of control patients: A systematic review and meta-analysis

Abstract

Objectives: This study attempted to identify the relationship between antibiotic exposure and risk of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection.

Methods: Antibiotic exposure was analysed as a risk factor for CRKP infection, cases of which were extracted from research articles indexed in PubMed, EMBASE, and the Cochrane Library. Relevant studies published until January 2023 were reviewed, and a meta-analysis was conducted on antibiotic exposure within four types of control groups, which comprised 52 studies.

Results: The four types of control groups included carbapenem-susceptible K. pneumoniae infections (CSKP; comparison 1); other infections, especially without CRKP infection (comparison 2); CRKP colonisation (comparison 3); and no infection (comparison 4). Carbapenems exposure and Aminoglycosides exposure were two risk factors common to the four comparison groups. Compared with the risk of CSKP infection, tigecycline exposure in bloodstream infections and quinolone exposure within 30 days were associated with an increased risk of CRKP infection. However, the risk of CRKP infection associated with tigecycline exposure in mixed (MIX) infections (infections involving two or more different infection sites) and quinolone exposure within 90 days was similar to the risk of CSKP infection.

Conclusion: Carbapenems and Aminoglycosides exposure are likely risk factors for CRKP infection. Antibiotic exposure time as a continuous variable was not associated with the risk of CRKP infection, compared with the risk of CSKP infection. Tigecycline exposure in MIX infections and quinolone exposure within 90 days may not increase the risk of CRKP infection.

Keywords: Antibiotic exposure; Carbapenem-resistant Klebsiella pneumonia; Review and meta-analysis; Risk factor.