Prevalence, Risk Factors, and Clinical Outcomes of Hypervirulent Klebsiella pneumoniae Strains among Klebsiella pneumoniae Infections: A Systematic Review and Meta-analysis.

IF 1.5 Q3 CRITICAL CARE MEDICINE

Indian Journal of Critical Care Medicine Pub Date : 2025-04-01 DOI:10.5005/jp-journals-10071-24957

Danavath Nagendra, Souvik Chaudhuri, Nitin Gupta, Vishal Shanbhag, Vandana K Eshwara, Shwethapriya Rao, Muralidhar Varma, Thejesh Srinivas, Pratibha Todur, P S Priya, Vinutha R Bhat

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Abstract

Aim and background: Hypervirulent Klebsiella pneumoniae (HvKp) is a virulent strain associated with invasive infections. While initially community-acquired, hospital-acquired HvKp (HA-HvKp) and carbapenem-resistant HvKp (CR-HvKp) are increasingly reported. This meta-analysis evaluates the prevalence, risk factors, and clinical outcomes associated with HvKp, including CR-HvKp and HA-HvKp, among Kp infections.

Methodology: A systematic search of PubMed, Scopus, Embase, and Cochrane Library was conducted until December 2024. Observational studies comparing HvKp vs classical Kp (cKp), CR-HvKp vs carbapenem-sensitive HvKp (CS-HvKp), and HA-HvKp vs community-acquired HvKp (CA-HvKp) were included. Quality was assessed using the Joanna Briggs Critical Appraisal Tool, and pooled prevalence and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

Results: Fifty studies with 6,663 participants were included. The HvKp prevalence was 33.0%, with most studies from Asia, predominantly China. Temporal analysis revealed an increase in HvKp prevalence (27.7% in 2006-2018 to 38.5% in 2019-2024). The CR-HvKp prevalence rose from 9.5% to 16.5% (2016-2024). The HA-HvKp prevalence increased from 25.9 to 47.1%. Key risk factors included diabetes mellitus (OR = 1.56), CA-Kp (OR = 2.59), and hypermucoviscous (HM)-phenotype (OR = 29.79). Complications included liver abscess (OR = 6.35), metastatic spread (OR = 4.74), meningitis (OR = 11.14), and septic shock (OR = 1.30). Mortality was higher in HvKp infections but not statistically significant (p = 0.219). HA-HvKp and immunosuppression were significant CR-HvKp risk factors, with CR-HvKp showing higher mortality.

Conclusions: Diabetes mellitus, CA-Kp infections, and HM-phenotype are significant risk factors for HvKp. The rising prevalence of CR-HvKp and HA-HvKp highlights the need for early detection, infection control, and targeted treatment strategies.

How to cite this article: Nagendra D, Chaudhuri S, Gupta N, Shanbhag V, Eshwara VK, Rao S, et al. Prevalence, Risk Factors, and Clinical Outcomes of Hypervirulent Klebsiella pneumoniae Strains among Klebsiella pneumoniae Infections: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2025;29(4):370-393.

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肺炎克雷伯菌感染中高毒力肺炎克雷伯菌株的患病率、危险因素和临床结果：系统综述和荟萃分析

目的和背景：高毒力肺炎克雷伯菌（HvKp）是一种与侵袭性感染相关的毒力菌株。虽然最初是社区获得性，但医院获得性HvKp （HA-HvKp）和碳青霉烯耐药HvKp （CR-HvKp）的报道越来越多。本荟萃分析评估了Kp感染中与HvKp相关的患病率、危险因素和临床结果，包括CR-HvKp和HA-HvKp。方法：系统检索PubMed， Scopus， Embase和Cochrane图书馆，直到2024年12月。包括比较HvKp与经典Kp （cKp）、CR-HvKp与碳青霉烯敏感HvKp （CS-HvKp）、HA-HvKp与社区获得性HvKp （CA-HvKp）的观察性研究。使用Joanna Briggs关键评估工具评估质量，并计算95%置信区间（ci）的合并患病率和优势比（ORs）。结果：纳入了50项研究，6663名参与者。HvKp患病率为33.0%，大多数研究来自亚洲，主要是中国。时间分析显示，HvKp患病率上升（2006-2018年为27.7%，2019-2024年为38.5%）。CR-HvKp患病率从9.5%上升到16.5%（2016-2024年）。HA-HvKp患病率从25.9%上升到47.1%。关键危险因素包括糖尿病（OR = 1.56）、CA-Kp （OR = 2.59）和高粘滞（HM）表型（OR = 29.79）。并发症包括肝脓肿（OR = 6.35）、转移性扩散（OR = 4.74）、脑膜炎（OR = 11.14）和感染性休克（OR = 1.30）。HvKp感染的死亡率较高，但无统计学意义（p = 0.219）。HA-HvKp和免疫抑制是CR-HvKp的重要危险因素，CR-HvKp显示更高的死亡率。结论：糖尿病、CA-Kp感染和hm表型是HvKp的重要危险因素。CR-HvKp和HA-HvKp的流行率不断上升，突出了早期发现、感染控制和有针对性治疗策略的必要性。如何引用本文：Nagendra D， Chaudhuri S, Gupta N, Shanbhag V, Eshwara VK， Rao S等。肺炎克雷伯菌感染中高毒力肺炎克雷伯菌株的患病率、危险因素和临床结果：系统综述和荟萃分析中华检验医学杂志，2015;29(4):370-393。

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来源期刊

Indian Journal of Critical Care Medicine CRITICAL CARE MEDICINE-

CiteScore

3.50

自引率

10.00%

发文量

299

期刊介绍： Indian Journal of Critical Care Medicine (ISSN 0972-5229) is specialty periodical published under the auspices of Indian Society of Critical Care Medicine. Journal encourages research, education and dissemination of knowledge in the fields of critical and emergency medicine.