BACKGROUND Studies on risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) infection have provided inconsistent results, partly due to the choice of the control group. We conducted a systematic review and meta-analysis to assess the risk factors for CRKP infection by comparing CRKP-infected patients with two types of controls: patients infected with carbapenem-susceptible Klebsiella pneumoniae (comparison 1) or patients not infected with CRKP (comparison 2). METHODS Data on potentially relevant risk factors for CRKP infection were extracted from studies indexed in PubMed, EMBASE, Web of Science or EBSCO databases from January 1996 to April 2019, and meta-analyzed based on the outcomes for each type of comparison. RESULTS The meta-analysis included 18 studies for comparison 1 and 14 studies for comparison 2. The following eight risk factors were common to both comparisons: admission to intensive care unit (ICU; odds ratio, ORcomparison 1 = 3.20, ORcomparison 2 = 4.44), central venous catheter use (2.62, 3.85), mechanical ventilation (2.70, 4.78), tracheostomy (2.11, 8.48), urinary catheter use (1.99, 0.27), prior use of antibiotic (6.07, 1.61), exposure to carbapenems (4.16, 3.84) and exposure to aminoglycosides (1.85, 1.80). Another 10 risk factors were unique to comparison 1: longer length of hospital stay (OR = 15.28); prior hospitalization (within the previous 6 months) (OR = 1.91); renal dysfunction (OR = 2.17); neurological disorders (OR = 1.52); nasogastric tube use (OR = 2.62); dialysis (OR = 3.56); and exposure to quinolones (OR = 2.11), fluoroquinolones (OR = 2.03), glycopeptides (OR = 3.70) and vancomycin (OR = 2.82). CONCLUSIONS Eighteen factors may increase the risk of carbapenem resistance in K. pneumoniae infection; eight factors may be associated with both K. pneumoniae infections in general and CRKP in particular. The eight shared factors are likely to be 'true' risk factors for CRKP infection. Evaluation of risk factors in different situations may be helpful for empirical treatment and prevention of CRKP infections.

中文翻译：

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相对于两种类型的对照患者，对碳青霉烯耐药的肺炎克雷伯菌感染的危险因素：系统评价和荟萃分析。

背景技术对耐碳青霉烯类肺炎克雷伯菌（CRKP）感染的危险因素的研究结果不一致，部分原因是由于选择了对照组。我们进行了系统的回顾和荟萃分析，通过将感染了CRKP的患者与两种类型的对照进行比较来评估CRKP感染的风险因素：感染了碳青霉烯易感肺炎克雷伯菌的患者（比较1）或未感染CRKP的患者（比较2）。 ）。方法从1996年1月至2019年4月在PubMed，EMBASE，Web of Science或EBSCO数据库中索引的研究中提取有关CRKP感染的潜在相关危险因素的数据，并根据每种比较的结果进行荟萃分析。结果荟萃分析包括18项比较1的研究和14项比较2的研究。以下8个风险因素是两个比较的共同点：重症监护病房的入院率（ICU；优势比，OR比较1 = 3.20，OR比较2 = 4.44），中心静脉导管使用（2.62，3.85），机械通气（2.70，4.78） ，气管切开术（2.11、8.48），使用导尿管（1.99、0.27），在先使用抗生素（6.07、1.61），接触碳青霉烯（4.16、3.84）和接触氨基糖苷（1.85、1.80）。比较中还存在另外10个危险因素：1，住院时间更长（OR = 15.28）；先前的住院治疗（在过去的六个月内）（OR = 1.91）；肾功能不全（OR = 2.17）；神经系统疾病（OR = 1.52）；使用鼻胃管（OR = 2.62）; 透析（OR = 3.56）；并暴露于喹诺酮（OR = 2.11），氟喹诺酮（OR = 2.03），糖肽（OR = 3.70）和万古霉素（OR = 2.82）。结论十八个因素可能会增加肺炎克雷伯菌感染中碳青霉烯耐药的风险。八个因素可能与一般的肺炎克雷伯菌感染有关，特别是与CRKP有关。八个共有因素可能是CRKP感染的“真实”危险因素。评估不同情况下的危险因素可能有助于经验性治疗和预防CRKP感染。