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Meta-Analysis
. 2023 Apr 20:13:1157010.
doi: 10.3389/fcimb.2023.1157010. eCollection 2023.

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

Dan Li  1   2   3 , Xiangning Huang  2 , Huayun Rao  3 , Hua Yu  2 , Shanshan Long  2 , Yulian Li  4 , Jie Zhang  2
Affiliations
Meta-Analysis

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

Dan Li et al. Front Cell Infect Microbiol. .

Abstract

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 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.

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.

Keywords: Klebsiella pneumoniae; bacteremia; carbapenem-resistant; meta-analysis; mortality.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow of diagram of meta-analysis generated by PRISMA2020.
Figure 2
Figure 2
Forest plot of single proportion 30-day mortality for KPB.
Figure 3
Figure 3
Forest plot of 30-day mortality for CRKP vs non-CRKP KPB.
See this image and copyright information in PMC

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