Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae

Abstract

PurposeCarbapenem resistant K. pneumoniae (CRKP) has aroused widespread attention owing to its very limited therapeutic options, and this strain has increased rapidly in recent years. Although it is accepted that drug resistance is associated with increased mortality in general, but some other studies found no such relationship. To estimate mortality of patients infected with CRKP in general and analyze factors for mortality of this infection, thus, we conducted this systematic review and meta-analysis.MethodsA systematic literature review of relevant studies published until December 2015 was conducted. We selected and assessed articles reporting mortality of patients infected with CRKP.ResultsPooled mortality was 42.14% among 2462 patients infected with CRKP versus 21.16% in those infected with carbapenem-susceptible K. pneumoniae (CSKP). The mortality of patients with bloodstream infection (BSI) or urinary tract infection was 54.30 and 13.52%, respectively, and 48.9 and 43.13% in patients admitted to the intensive care unit (ICU) or who underwent solid organ transplantation (SOT). Mortality was 47.66% in patients infected with K. pneumoniae carbapenemase-producing K. pneumoniae and 46.71% in those infected with VIM-producing K. pneumoniae. Geographically, mortality reported in studies from North America, South America, Europe, and Asia was 33.24, 46.71, 50.06, and 44.82%, respectively.ConclusionsOur study suggests that patients infected with CRKP have higher mortality than those infected with CSKP, especially in association with BSI, ICU admission, or SOT. We also considered that patients’ survival has a close relationship with their physical condition. Our results imply that attention should be paid to CRKP infection, and that strict infection control measures and new antibiotics are required to protect against CRKP infection.

Infections due to multidrug‐resistant organisms following heart transplantation: Epidemiology, microbiology, and outcomes

“…Definitions used for MDRO have recently been standardized with classification into MDR, XDR, and PDR . SOT recipients are at high risk for developing MDRO infections; and this has been best described in the abdominal transplant population . To the best of our knowledge, this is the first study to specifically describe the epidemiology, clinical manifestations, microbiologic spectrum, and outcomes associated with MDRO infections in a large cohort of heart transplant recipients.…”

“…and this has been best described in the abdominal transplant population. [4][5][6] To the best of our knowledge, this is the first study to specifically describe the epidemiology, clinical manifestations, microbiologic spectrum, and outcomes associated with MDRO infections in a large cohort of heart transplant recipients.…”

“…Infections due to multidrug‐resistant organisms (MDRO) are a growing problem in solid organ transplantation (SOT), and management is challenging due to limited therapeutics . Solid organ transplantation has been described as a risk factor for MDRO infections and is associated with increased mortality in comparison with non‐MDRO infections . The majority of published literature pertains to abdominal organ transplantation and is focused primarily on infections due to carbapenem‐resistant Klebsiella pneumoniae (CRKP) .…”

“…mortality in comparison with non-MDRO infections. [4][5][6] The majority of published literature pertains to abdominal organ transplantation and is focused primarily on infections due to carbapenem-resistant Klebsiella pneumoniae (CRKP). 4,7 While thoracic SOT recipients have been found to be at risk for MDRO infections, 4,8 data specific to heart transplantation are limited.…”

Antibiotic stewardship – it starts with you!

“…Studies have shown that mortality is significantly higher in patients infected with resistant organisms when compared with more susceptible organisms of the same species. [2] The reasons for this may be multiple, but factors include underlying comorbidities, inappropriate initial therapy, suboptimal dosing of antibiotics in critical illness and selection of resistance by inappropriate use of antibiotics. [3] Antibiotic stewardship is a strategy to preserve the life-saving power of antibiotics.…”