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Klebsiella pneumoniae bacteremia mortality: a systematic review and meta-analysis

OBJECTIVE: To analyze the mortality rate of patients with Klebsiella pneumoniae bacteremia (KPB) and the impact of extended spectrum beta-lactamase (ESBL) producing or carbapenem-resistance (CR) KP on the mortality rate among patients with bacteremia. METHODS: EMbase, Web of Science, PubMed, and The...

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Autores principales: Li, Dan, Huang, Xiangning, Rao, Huayun, Yu, Hua, Long, Shanshan, Li, Yulian, Zhang, Jie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10159367/
https://www.ncbi.nlm.nih.gov/pubmed/37153146
http://dx.doi.org/10.3389/fcimb.2023.1157010
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author Li, Dan
Huang, Xiangning
Rao, Huayun
Yu, Hua
Long, Shanshan
Li, Yulian
Zhang, Jie
author_facet Li, Dan
Huang, Xiangning
Rao, Huayun
Yu, Hua
Long, Shanshan
Li, Yulian
Zhang, Jie
author_sort Li, Dan
collection PubMed
description OBJECTIVE: To analyze the mortality rate of patients with Klebsiella pneumoniae bacteremia (KPB) and the impact of extended spectrum beta-lactamase (ESBL) producing or carbapenem-resistance (CR) KP on the mortality rate among patients with bacteremia. METHODS: EMbase, Web of Science, PubMed, and The Cochrane Library were searched up to September 18(th), 2022. Two reviewers independently extracted data and evaluated risk of bias of included studies by ROBINS-I tool. A meta-regression analysis was conducted using a mixed-effects model to explore possible sources of heterogeneity. A random-effects model was used for pooled analysis in case of significant heterogeneity (I(2)>50%). Otherwise, the fixed-effects model was performed. RESULTS: A total of 157 studies (37,915 enrolled patients) were included in the meta-analysis. The pooled death proportions of KPB were 17% (95% CI=0.14-0.20) at 7-day, 24% (95% CI=0.21-0.28) at 14-day, 29% (95% CI=0.26-0.31) at 30-day, 34% (95% CI=0.26-0.42) at 90-day, and 29% (95% CI=0.26-0.33) in hospital, respectively. Heterogeneity was found from the intensive care unit (ICU), hospital-acquired (HA), CRKP, and ESBL-KP in the meta-regression analysis. More than 50% of ICU, HA, CRKP, and ESBL-KP were associated with a significant higher 30-day mortality rates. The pooled mortality odds ratios (ORs) of CRKP vs. non-CRKP were 3.22 (95% CI 1.18-8.76) at 7-day, 5.66 (95% CI 4.31-7.42) at 14-day, 3.87 (95% CI 3.01-3.49) at 28- or 30-day, and 4.05 (95% CI 3.38-4.85) in hospital, respectively. CONCLUSIONS: This meta-analysis indicated that patients with KPB in ICU, HA-KPB, CRKP, and ESBL-KP bacteremia were associated with a higher mortality rate. The high mortality rate caused by CRKP bacteremia has increased over time, challenging the public health.
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spelling pubmed-101593672023-05-05 Klebsiella pneumoniae bacteremia mortality: a systematic review and meta-analysis Li, Dan Huang, Xiangning Rao, Huayun Yu, Hua Long, Shanshan Li, Yulian Zhang, Jie Front Cell Infect Microbiol Cellular and Infection Microbiology OBJECTIVE: To analyze the mortality rate of patients with Klebsiella pneumoniae bacteremia (KPB) and the impact of extended spectrum beta-lactamase (ESBL) producing or carbapenem-resistance (CR) KP on the mortality rate among patients with bacteremia. METHODS: EMbase, Web of Science, PubMed, and The Cochrane Library were searched up to September 18(th), 2022. Two reviewers independently extracted data and evaluated risk of bias of included studies by ROBINS-I tool. A meta-regression analysis was conducted using a mixed-effects model to explore possible sources of heterogeneity. A random-effects model was used for pooled analysis in case of significant heterogeneity (I(2)>50%). Otherwise, the fixed-effects model was performed. RESULTS: A total of 157 studies (37,915 enrolled patients) were included in the meta-analysis. The pooled death proportions of KPB were 17% (95% CI=0.14-0.20) at 7-day, 24% (95% CI=0.21-0.28) at 14-day, 29% (95% CI=0.26-0.31) at 30-day, 34% (95% CI=0.26-0.42) at 90-day, and 29% (95% CI=0.26-0.33) in hospital, respectively. Heterogeneity was found from the intensive care unit (ICU), hospital-acquired (HA), CRKP, and ESBL-KP in the meta-regression analysis. More than 50% of ICU, HA, CRKP, and ESBL-KP were associated with a significant higher 30-day mortality rates. The pooled mortality odds ratios (ORs) of CRKP vs. non-CRKP were 3.22 (95% CI 1.18-8.76) at 7-day, 5.66 (95% CI 4.31-7.42) at 14-day, 3.87 (95% CI 3.01-3.49) at 28- or 30-day, and 4.05 (95% CI 3.38-4.85) in hospital, respectively. CONCLUSIONS: This meta-analysis indicated that patients with KPB in ICU, HA-KPB, CRKP, and ESBL-KP bacteremia were associated with a higher mortality rate. The high mortality rate caused by CRKP bacteremia has increased over time, challenging the public health. Frontiers Media S.A. 2023-04-20 /pmc/articles/PMC10159367/ /pubmed/37153146 http://dx.doi.org/10.3389/fcimb.2023.1157010 Text en Copyright © 2023 Li, Huang, Rao, Yu, Long, Li and Zhang https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cellular and Infection Microbiology
Li, Dan
Huang, Xiangning
Rao, Huayun
Yu, Hua
Long, Shanshan
Li, Yulian
Zhang, Jie
Klebsiella pneumoniae bacteremia mortality: a systematic review and meta-analysis
title Klebsiella pneumoniae bacteremia mortality: a systematic review and meta-analysis
title_full Klebsiella pneumoniae bacteremia mortality: a systematic review and meta-analysis
title_fullStr Klebsiella pneumoniae bacteremia mortality: a systematic review and meta-analysis
title_full_unstemmed Klebsiella pneumoniae bacteremia mortality: a systematic review and meta-analysis
title_short Klebsiella pneumoniae bacteremia mortality: a systematic review and meta-analysis
title_sort klebsiella pneumoniae bacteremia mortality: a systematic review and meta-analysis
topic Cellular and Infection Microbiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10159367/
https://www.ncbi.nlm.nih.gov/pubmed/37153146
http://dx.doi.org/10.3389/fcimb.2023.1157010
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