PDF(Sci-hub)
Abstract：
OBJECTIVE: Carbapenem 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.
METHODS: A systematic literature review of relevant studies published until December 2015 was conducted. We selected and assessed articles reporting mortality of patients infected with CRKP.
RESULTS: Pooled 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.
CONCLUSIONS: Our 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.
METHODS: A systematic literature review of relevant studies published until December 2015 was conducted. We selected and assessed articles reporting mortality of patients infected with CRKP.
RESULTS: Pooled 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.
CONCLUSIONS: Our 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.
摘要：
目的：耐碳青霉烯类肺炎克雷伯菌（CRKP）由于其治疗选择非常有限而引起了广泛的关注，近年来，这种菌株迅速增加。尽管人们普遍认为耐药性与死亡率增加有关，但是其他一些研究发现没有这种关系。评估CRKP感染患者的一般死亡率，并分析其死亡率的影响因素。因此，我们进行了系统综述和荟萃分析.
方法：对截至2015年12月发表的相关研究进行了系统的文献综述。我们选择并评估报告CRKP感染患者死亡率的文章。
结果：2462例感染CRKP患者的总死亡率为42.14%，而碳青霉烯类易感肺炎克雷伯菌(CSKP)患者的总死亡率为21.16%。血流感染(BSI)或尿路感染患者死亡率分别为54.30%和13.52%,分别,入住重症监护病房（ICU）或接受实体器官移植（SOT）的患者分别为48.9％和43.13％。感染产生碳青霉烯酶的肺炎克雷伯菌的患者死亡率为47.66％，感染产生VIM的肺炎克雷伯菌的患者死亡率为46.71％。地理上,在北美的研究中报告的死亡率，南美洲,欧洲,亚洲分别为33.24、46.71、50.06和44.82%，分别。
结论：我们的研究表明，感染CRKP的患者死亡率高于感染CSKP的患者，特别是与BSI有关，入住ICU,或SOT。我们还认为患者的生存与他们的身体状况密切相关。我们的结果表明，应该注意CRKP感染，并且需要严格的感染控制措施和新的抗生素来防止CRKP感染。
方法：对截至2015年12月发表的相关研究进行了系统的文献综述。我们选择并评估报告CRKP感染患者死亡率的文章。
结果：2462例感染CRKP患者的总死亡率为42.14%，而碳青霉烯类易感肺炎克雷伯菌(CSKP)患者的总死亡率为21.16%。血流感染(BSI)或尿路感染患者死亡率分别为54.30%和13.52%,分别,入住重症监护病房（ICU）或接受实体器官移植（SOT）的患者分别为48.9％和43.13％。感染产生碳青霉烯酶的肺炎克雷伯菌的患者死亡率为47.66％，感染产生VIM的肺炎克雷伯菌的患者死亡率为46.71％。地理上,在北美的研究中报告的死亡率，南美洲,欧洲,亚洲分别为33.24、46.71、50.06和44.82%，分别。
结论：我们的研究表明，感染CRKP的患者死亡率高于感染CSKP的患者，特别是与BSI有关，入住ICU,或SOT。我们还认为患者的生存与他们的身体状况密切相关。我们的结果表明，应该注意CRKP感染，并且需要严格的感染控制措施和新的抗生素来防止CRKP感染。
