Resistance profile and influence factors of carbapenem-resistant Klebsiella pneumoniae (CRKP) causing infections in China: a systematic review and meta-analysis.

Abstract

The prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections has surged in China over the past decade, posing a significant public health concern. However, comprehensive data on CRKP antimicrobial resistance patterns and the impact of the COVID-19 pandemic on these patterns in China remain unclear. We conducted a systematic review of CRKP infections in China, utilizing data from PubMed spanning 2006 to July 2023. We focused on resistance rates of CRKP causing infections, examining variations across time, regions, and age groups, as well as factors contributing to antimicrobial resistance. Our analysis included 68 studies from 19 provinces in China, comprising 1,284 CRKP isolates obtained from 779 patients. The overall mortality rate for CRKP infections in China was 27% (95% CI: 0.14-0.41, I² = 73%, k = 47), with ST11 being the predominant sequence type (Pooled Rate: 80%, 95% CI: 0.67-0.90, I² = 86%, k = 31). Temporal and spatial analyses indicated increased resistance to ciprofloxacin (Random effects model: Q_b = 9.88, df = 1, P < 0.010) and levofloxacin (Random effects model: Q_b = 7.69, df = 1, P < 0.010) during the COVID-19 pandemic. Resistance to chloramphenicol (Random effects model: Q_b = 4.97, df = 1, P = 0.030) and ceftazidime-avibactam (Random effects model: Q_b = 8.58, df = 1, P < 0.010) was lower in southern regions, while tetracycline resistance (Random effects model: Q_b = 9.69, df = 1, P < 0.010) was lower in the north. Higher resistance rates were observed in adults and the elderly. Age and geographic location were key factors associated with antimicrobial resistance. Fourteen out of thirty-five drugs showed a positive correlation with mortality rates, emphasizing their significant impact on CRKP infection mortality. This study underscores the need for targeted interventions to address regional and age-related variations in CRKP resistance and highlights the critical role of antimicrobial resistance in influencing mortality outcomes.