{"title":"中国碳青霉烯耐药肺炎克雷伯菌（CRKP）致感染的耐药概况及影响因素：系统综述和荟萃分析","authors":"Xiaolu Yang, Zhenghao Lou, Xinrui Wang, Zhen Li, Qiyu Liu, Kexin Guo, Yu Yang, Lu Gong, Kun Wang, Hao Xu, Beiwen Zheng, Wenhong Liu, Chuanxi Fu, Hui Chen, Xiawei Jiang","doi":"10.1186/s12941-025-00827-2","DOIUrl":null,"url":null,"abstract":"<p><p>The prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections has surged in China over the past decade, posing a significant public health concern. However, comprehensive data on CRKP antimicrobial resistance patterns and the impact of the COVID-19 pandemic on these patterns in China remain unclear. We conducted a systematic review of CRKP infections in China, utilizing data from PubMed spanning 2006 to July 2023. We focused on resistance rates of CRKP causing infections, examining variations across time, regions, and age groups, as well as factors contributing to antimicrobial resistance. Our analysis included 68 studies from 19 provinces in China, comprising 1,284 CRKP isolates obtained from 779 patients. The overall mortality rate for CRKP infections in China was 27% (95% CI: 0.14-0.41, I<sup>2</sup> = 73%, k = 47), with ST11 being the predominant sequence type (Pooled Rate: 80%, 95% CI: 0.67-0.90, I<sup>2</sup> = 86%, k = 31). Temporal and spatial analyses indicated increased resistance to ciprofloxacin (Random effects model: Q<sub>b</sub> = 9.88, df = 1, P < 0.010) and levofloxacin (Random effects model: Q<sub>b</sub> = 7.69, df = 1, P < 0.010) during the COVID-19 pandemic. Resistance to chloramphenicol (Random effects model: Q<sub>b</sub> = 4.97, df = 1, P = 0.030) and ceftazidime-avibactam (Random effects model: Q<sub>b</sub> = 8.58, df = 1, P < 0.010) was lower in southern regions, while tetracycline resistance (Random effects model: Q<sub>b</sub> = 9.69, df = 1, P < 0.010) was lower in the north. Higher resistance rates were observed in adults and the elderly. Age and geographic location were key factors associated with antimicrobial resistance. Fourteen out of thirty-five drugs showed a positive correlation with mortality rates, emphasizing their significant impact on CRKP infection mortality. This study underscores the need for targeted interventions to address regional and age-related variations in CRKP resistance and highlights the critical role of antimicrobial resistance in influencing mortality outcomes.</p>","PeriodicalId":8052,"journal":{"name":"Annals of Clinical Microbiology and Antimicrobials","volume":"24 1","pages":"56"},"PeriodicalIF":3.6000,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519821/pdf/","citationCount":"0","resultStr":"{\"title\":\"Resistance profile and influence factors of carbapenem-resistant Klebsiella pneumoniae (CRKP) causing infections in China: a systematic review and meta-analysis.\",\"authors\":\"Xiaolu Yang, Zhenghao Lou, Xinrui Wang, Zhen Li, Qiyu Liu, Kexin Guo, Yu Yang, Lu Gong, Kun Wang, Hao Xu, Beiwen Zheng, Wenhong Liu, Chuanxi Fu, Hui Chen, Xiawei Jiang\",\"doi\":\"10.1186/s12941-025-00827-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>The prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections has surged in China over the past decade, posing a significant public health concern. However, comprehensive data on CRKP antimicrobial resistance patterns and the impact of the COVID-19 pandemic on these patterns in China remain unclear. We conducted a systematic review of CRKP infections in China, utilizing data from PubMed spanning 2006 to July 2023. We focused on resistance rates of CRKP causing infections, examining variations across time, regions, and age groups, as well as factors contributing to antimicrobial resistance. Our analysis included 68 studies from 19 provinces in China, comprising 1,284 CRKP isolates obtained from 779 patients. The overall mortality rate for CRKP infections in China was 27% (95% CI: 0.14-0.41, I<sup>2</sup> = 73%, k = 47), with ST11 being the predominant sequence type (Pooled Rate: 80%, 95% CI: 0.67-0.90, I<sup>2</sup> = 86%, k = 31). Temporal and spatial analyses indicated increased resistance to ciprofloxacin (Random effects model: Q<sub>b</sub> = 9.88, df = 1, P < 0.010) and levofloxacin (Random effects model: Q<sub>b</sub> = 7.69, df = 1, P < 0.010) during the COVID-19 pandemic. Resistance to chloramphenicol (Random effects model: Q<sub>b</sub> = 4.97, df = 1, P = 0.030) and ceftazidime-avibactam (Random effects model: Q<sub>b</sub> = 8.58, df = 1, P < 0.010) was lower in southern regions, while tetracycline resistance (Random effects model: Q<sub>b</sub> = 9.69, df = 1, P < 0.010) was lower in the north. Higher resistance rates were observed in adults and the elderly. Age and geographic location were key factors associated with antimicrobial resistance. Fourteen out of thirty-five drugs showed a positive correlation with mortality rates, emphasizing their significant impact on CRKP infection mortality. This study underscores the need for targeted interventions to address regional and age-related variations in CRKP resistance and highlights the critical role of antimicrobial resistance in influencing mortality outcomes.</p>\",\"PeriodicalId\":8052,\"journal\":{\"name\":\"Annals of Clinical Microbiology and Antimicrobials\",\"volume\":\"24 1\",\"pages\":\"56\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-10-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519821/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Clinical Microbiology and Antimicrobials\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12941-025-00827-2\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MICROBIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Clinical Microbiology and Antimicrobials","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12941-025-00827-2","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MICROBIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
在过去的十年中，中国耐碳青霉烯类肺炎克雷伯菌（CRKP）感染的流行率激增，引起了重大的公共卫生关注。然而，关于中国CRKP抗微生物药物耐药性模式的综合数据以及COVID-19大流行对这些模式的影响仍不清楚。我们利用PubMed从2006年到2023年7月的数据，对中国的CRKP感染进行了系统回顾。我们重点关注CRKP引起感染的耐药率，检查不同时间、地区和年龄组的变化，以及导致抗菌素耐药性的因素。我们的分析纳入了来自中国19个省份的68项研究，包括从779例患者中获得的1,284株CRKP分离株。中国CRKP感染的总死亡率为27% (95% CI: 0.14-0.41, I2 = 73%, k = 47)， ST11是主要的序列类型（合并率：80%，95% CI: 0.67-0.90, I2 = 86%, k = 31）。时空分析表明，环丙沙星（随机效应模型：Qb = 9.88, df = 1, P b = 7.69, df = 1, P b = 4.97, df = 1, P = 0.030）和头孢他啶-阿维巴坦(随机效应模型：Qb = 8.58, df = 1, P b = 9.69, df = 1， P
Resistance profile and influence factors of carbapenem-resistant Klebsiella pneumoniae (CRKP) causing infections in China: a systematic review and meta-analysis.
The prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections has surged in China over the past decade, posing a significant public health concern. However, comprehensive data on CRKP antimicrobial resistance patterns and the impact of the COVID-19 pandemic on these patterns in China remain unclear. We conducted a systematic review of CRKP infections in China, utilizing data from PubMed spanning 2006 to July 2023. We focused on resistance rates of CRKP causing infections, examining variations across time, regions, and age groups, as well as factors contributing to antimicrobial resistance. Our analysis included 68 studies from 19 provinces in China, comprising 1,284 CRKP isolates obtained from 779 patients. The overall mortality rate for CRKP infections in China was 27% (95% CI: 0.14-0.41, I2 = 73%, k = 47), with ST11 being the predominant sequence type (Pooled Rate: 80%, 95% CI: 0.67-0.90, I2 = 86%, k = 31). Temporal and spatial analyses indicated increased resistance to ciprofloxacin (Random effects model: Qb = 9.88, df = 1, P < 0.010) and levofloxacin (Random effects model: Qb = 7.69, df = 1, P < 0.010) during the COVID-19 pandemic. Resistance to chloramphenicol (Random effects model: Qb = 4.97, df = 1, P = 0.030) and ceftazidime-avibactam (Random effects model: Qb = 8.58, df = 1, P < 0.010) was lower in southern regions, while tetracycline resistance (Random effects model: Qb = 9.69, df = 1, P < 0.010) was lower in the north. Higher resistance rates were observed in adults and the elderly. Age and geographic location were key factors associated with antimicrobial resistance. Fourteen out of thirty-five drugs showed a positive correlation with mortality rates, emphasizing their significant impact on CRKP infection mortality. This study underscores the need for targeted interventions to address regional and age-related variations in CRKP resistance and highlights the critical role of antimicrobial resistance in influencing mortality outcomes.
期刊介绍：
Annals of Clinical Microbiology and Antimicrobials considers good quality, novel and international research of more than regional relevance. Research must include epidemiological and/or clinical information about isolates, and the journal covers the clinical microbiology of bacteria, viruses and fungi, as well as antimicrobial treatment of infectious diseases.
Annals of Clinical Microbiology and Antimicrobials is an open access, peer-reviewed journal focusing on information concerning clinical microbiology, infectious diseases and antimicrobials. The management of infectious disease is dependent on correct diagnosis and appropriate antimicrobial treatment, and with this in mind, the journal aims to improve the communication between laboratory and clinical science in the field of clinical microbiology and antimicrobial treatment. Furthermore, the journal has no restrictions on space or access; this ensures that the journal can reach the widest possible audience.
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