# Risk factors for carbapenem-resistant Klebsiella pneumoniae infection in hospitalized patients: a meta-analysis

## TL;DR

This study identifies risk factors for CRKP infections in hospitals, highlighting procedures like endoscopy and regional differences in antibiotic use.

## Contribution

The study is the first to report endoscopy and surgical drainage as distinct risk factors for CRKP and reveals regional differences in infection risk factors.

## Key findings

- Endoscopy and surgical drainage are distinct risk factors for CRKP infection.
- Western populations show higher risks with cephalosporins and fluoroquinolones compared to Eastern populations.
- ICU admission and prior hospital stay are significant risk factors for CRKP infection.

## Abstract

Healthcare-associated infections due to carbapenem-resistant Klebsiella pneumoniae (CRKP) are a global public health threat with rising hospital morbidity and mortality. We conducted a meta-analysis to systematically identify CRKP infection risk factors.

We searched Medline, Embase, Web of Science, and Cochrane Library for studies published January 1991–December 2024. Pooled odds ratio (OR)/95% confidence intervals (CIs) were used to assess risk factors; publication bias was evaluated via funnel plots and Egger’s test, and robustness via leave-one-out sensitivity analysis.

Fifty-one studies (13,860 patients: 4,711 CRKP cases, 9,149 carbapenem-susceptible K. pneumoniae controls) were included, with 43 reported risk factors. Thirty-one were significant: demographic/underlying diseases [male sex (OR = 1.31), kidney diseases (OR = 1.47), respiratory system diseases (OR = 2.69), cardiovascular diseases (OR = 1.34)]; invasive procedures [endoscopy (OR = 4.08), tracheal cannula (OR = 3.72), mechanical ventilation (OR = 3.61)]; medical environment [ICU admission (OR = 4.27), pre-infection hospital stay (mean difference=14.98 days)]; antibiotics [tigecycline (OR = 5.97), carbapenems (OR = 4.79), which may reflect disease severity, prior colonization]. Subgroup analysis showed regional heterogeneity: Western populations had higher risks with cephalosporins (OR = 2.68 vs. Eastern 1.55) and fluoroquinolones (OR = 3.58 vs. Eastern 1.89), while Eastern populations had higher risks with invasive procedures (dialysis: OR = 4.47 vs. Western 2.03). Sensitivity analysis confirmed robust results.

This meta-analysis reports endoscopy and surgical drainage as distinct subtypes of invasive procedural factors associated with hospital-acquired CRKP infection and describes regional differences in associated factors between Eastern and Western populations. These findings, based on observational evidence, provide preliminary insights for targeted prevention strategies.

https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024628428.