Drug resistance phenotypes of clinical Klebsiella pneumoniae isolates in the past 20 years in China: A systematic review and meta-analysis

Abstract

Objectives: Monitoring the drug resistance phenotypes of Klebsiella pneumoniae is crucial in clinical practice. This study aims to evaluate the prevalence of drug resistance of clinical K. pneumoniae isolates in China over the past two decades using a systematic review and meta-analysis.

Methods: We systematically searched five databases for relevant articles published between January 1, 2003 and November 21, 2023. We assessed the resistance of clinical K. pneumoniae strains isolated in China over the past 20 years to 15 antibiotics, which were divided into three subgroups.

Results: A total of 177 studies derived from 160 articles were eligible for meta-analysis. The pooled antibiotic resistance rate ranged from 5.01% (for imipenem) to 96.03% (for ampicillin). The pooled rate of resistance to the carbapenem antibiotics imipenem and meropenem was relatively low, and subgroup analyses showed that these rates increased over time. The antibiotic resistance rate showed a geographic trend, being highest in central China and lowest in northwest China. The drug resistance rate was highest in strains isolated from specimens from patients with urinary tract infections.

Conclusion: This meta-analysis provides reliable data on the rate of antibiotic resistance of K. pneumoniae grouped according to isolation region, time, and source, which may be helpful for the selection of antibiotics for clinical treatment. Areas requiring specific attention include management of the use of carbapenem, improving the prevention and treatment of K. pneumoniae in patients with urinary tract infections, and control of transmission of strains from one region to another.

Keywords: Antibiotic resistance; Drug resistance; Klebsiella pneumoniae; Meta-analysis.