目的:为了应对全球对抗生素耐药性的日益关注,我们进行了一项荟萃分析,以评估高毒力肺炎克雷伯菌(hvKp)菌株对抗生素的耐药率.
方法:我们对hvKp菌株的抗生素耐药性进行了荟萃分析。通过对各种数据库的系统搜索,确定了直到2023年4月10日用英语发表的合格研究。删除重复项后,两位作者独立评估和分析了相关出版物,第三作者解决了任何差异。数据提取包括出版物细节和抗生素耐药性的关键信息。数据综合采用随机效应模型来解释异质性,并使用R和metafor包进行了各种统计分析。
结果:这项对来自17个国家的77项研究的荟萃分析揭示了hvKp菌株中抗生素耐药性的流行。已经观察到针对各种类别的抗生素的高耐药率。氨苄西林-舒巴坦面临45.3%的耐药性,分别,使他们基本上无效。头孢唑林第一代头孢菌素耐药率为38.1%,而第二代头孢呋辛显示26.7%的耐药性。第三代头孢菌素,头孢噻肟(65.8%)和头孢他啶(57.1%),和第四代头孢菌素,头孢吡肟(51.3%),表现出相当大的抵抗力。最后的碳青霉烯类药物,亚胺培南(45.7%),美罗培南(51.0%),和厄他培南(40.6%),没有幸免。结论结论:本研究强调了hvKp菌株中抗生素耐药性日益严重的问题,对旧的和新的抗生素都有明显的抵抗力,随着时间的推移增加阻力,地区差异,和方法上的变化。有效应对应包括国际合作,标准化测试,和量身定制的区域干预措施。
OBJECTIVE: In response to the growing global concerns regarding antibiotic resistance, we conducted a meta-analysis to assess the prevalence of antibiotic resistance in hypervirulent Klebsiella pneumoniae (hvKp) strains.
METHODS: We conducted a meta-analysis of antibiotic resistance in the hvKp strains. Eligible studies published in English until April 10, 2023, were identified through a systematic search of various databases. After removing duplicates, two authors independently assessed and analyzed the relevant publications, and a third author resolved any discrepancies. Data extraction included publication details and key information on antibiotic resistance. Data synthesis employed a random-effects model to account for heterogeneity, and various statistical analyses were conducted using R and the metafor package.
RESULTS: This meta-analysis of 77 studies from 17 countries revealed the prevalence of antibiotic resistance in hvKp strains. A high resistance rates have been observed against various classes of antibiotics. Ampicillin-sulbactam faced 45.3% resistance, respectively, rendering them largely ineffective. The first-generation cephalosporin cefazolin exhibited a resistance rate of 38.1%, whereas second-generation cefuroxime displayed 26.7% resistance. Third-generation cephalosporins, cefotaxime (65.8%) and ceftazidime (57.1%), and fourth-generation cephalosporins, cefepime (51.3%), showed substantial resistance. The last-resort carbapenems, imipenem (45.7%), meropenem (51.0%), and ertapenem (40.6%), were not spared. Conclusion CONCLUSION: This study emphasizes the growing issue of antibiotic resistance in hvKp strains, with notable resistance to both older and newer antibiotics, increasing resistance over time, regional disparities, and methodological variations. Effective responses should involve international cooperation, standardized testing, and tailored regional interventions.