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

IF 4.6 2区医学 Q1 INFECTIOUS DISEASES

International Journal of Antimicrobial Agents Pub Date : 2025-04-20 DOI:10.1016/j.ijantimicag.2025.107520

Wei Wei , Yueran Lian , Yao Peng , Biao Kan , Zhenpeng Li , Xin Lu

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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.

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近20年来中国肺炎克雷伯菌临床分离株的耐药表型：系统回顾和荟萃分析

目的：监测肺炎克雷伯菌的耐药表型在临床实践中具有重要意义。本研究旨在通过系统综述和荟萃分析来评估过去20年中国临床肺炎克雷伯菌分离株的耐药流行情况。方法：系统检索5个数据库2003年1月1日至2023年11月21日发表的相关文章。我们评估了过去20年在中国分离的临床肺炎克雷伯菌菌株对15种抗生素的耐药性，将其分为三个亚组。结果：来自160篇文章的177项研究符合meta分析。总耐药率为5.01%（亚胺培南）~ 96.03%（氨苄西林）。对碳青霉烯类抗生素亚胺培南和美罗培南的总耐药率相对较低，亚组分析显示这些耐药率随着时间的推移而增加。抗生素耐药率有明显的地理分布趋势，中部地区最高，西北地区最低。尿路感染患者标本中分离的菌株耐药率最高。结论：本荟萃分析提供了肺炎克雷伯菌按分离地区、时间和来源分组的耐药率的可靠数据，可为临床治疗抗生素的选择提供参考。需要特别注意的领域包括管理碳青霉烯类药物的使用，改善尿路感染患者肺炎克雷伯菌的预防和治疗，以及控制菌株从一个地区传播到另一个地区。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Antimicrobial Agents 医学-传染病学

CiteScore

21.60

自引率

0.90%

发文量

176

审稿时长

36 days

期刊介绍： The International Journal of Antimicrobial Agents is a peer-reviewed publication offering comprehensive and current reference information on the physical, pharmacological, in vitro, and clinical properties of individual antimicrobial agents, covering antiviral, antiparasitic, antibacterial, and antifungal agents. The journal not only communicates new trends and developments through authoritative review articles but also addresses the critical issue of antimicrobial resistance, both in hospital and community settings. Published content includes solicited reviews by leading experts and high-quality original research papers in the specified fields.