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Abstract：
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.
EMbase, Web of Science, PubMed, and The Cochrane Library were searched up to September 18th, 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 (I2>50%). Otherwise, the fixed-effects model was performed.
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.
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.
EMbase, Web of Science, PubMed, and The Cochrane Library were searched up to September 18th, 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 (I2>50%). Otherwise, the fixed-effects model was performed.
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.
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.
摘要：
■分析肺炎克雷伯菌菌血症（KPB）患者的死亡率以及产超广谱β-内酰胺酶（ESBL）或碳青霉烯耐药（CR）KP对菌血症患者死亡率的影响。
■EMBase,WebofScience,PubMed,直到9月18日，科克伦图书馆都被搜查了，2022年。两名评审员独立提取数据，并通过ROBINS-I工具评估纳入研究的偏倚风险。使用混合效应模型进行荟萃回归分析，以探索异质性的可能来源。在显著异质性(I2>50%)的情况下,使用随机效应模型进行汇总分析。否则,采用固定效应模型.
■共有157项研究（37,915名入选患者）纳入荟萃分析。在7天，KPB的合并死亡比例为17％（95％CI=0.14-0.20），24％（95％CI=0.21-0.28）在14天，29％（95％CI=0.26-0.31）在30天，在90天，34%（95%CI=0.26-0.42），29%(95%CI=0.26-0.33)在医院，分别。从重症监护病房(ICU)发现异质性，医院获得性（HA），CRKP,和ESBL-KP在荟萃回归分析中的应用。超过50％的ICU，HA,CRKP,和ESBL-KP与显著较高的30天死亡率相关.CRKP与CRKP的合并死亡率优势比(ORs)7天的非CRKP为3.22（95%CI1.18-8.76），14天时5.66（95%CI4.31-7.42），在28天或30天时为3.87（95%CI3.01-3.49），和4.05（95%CI3.38-4.85）在医院，分别。
■这项荟萃分析表明，ICU中的KPB患者，HA-KPB,CRKP,和ESBL-KP菌血症与较高的死亡率相关。CRKP菌血症引起的高死亡率随着时间的推移而增加，挑战公众健康。
■EMBase,WebofScience,PubMed,直到9月18日，科克伦图书馆都被搜查了，2022年。两名评审员独立提取数据，并通过ROBINS-I工具评估纳入研究的偏倚风险。使用混合效应模型进行荟萃回归分析，以探索异质性的可能来源。在显著异质性(I2>50%)的情况下,使用随机效应模型进行汇总分析。否则,采用固定效应模型.
■共有157项研究（37,915名入选患者）纳入荟萃分析。在7天，KPB的合并死亡比例为17％（95％CI=0.14-0.20），24％（95％CI=0.21-0.28）在14天，29％（95％CI=0.26-0.31）在30天，在90天，34%（95%CI=0.26-0.42），29%(95%CI=0.26-0.33)在医院，分别。从重症监护病房(ICU)发现异质性，医院获得性（HA），CRKP,和ESBL-KP在荟萃回归分析中的应用。超过50％的ICU，HA,CRKP,和ESBL-KP与显著较高的30天死亡率相关.CRKP与CRKP的合并死亡率优势比(ORs)7天的非CRKP为3.22（95%CI1.18-8.76），14天时5.66（95%CI4.31-7.42），在28天或30天时为3.87（95%CI3.01-3.49），和4.05（95%CI3.38-4.85）在医院，分别。
■这项荟萃分析表明，ICU中的KPB患者，HA-KPB,CRKP,和ESBL-KP菌血症与较高的死亡率相关。CRKP菌血症引起的高死亡率随着时间的推移而增加，挑战公众健康。
