Antibiotic resistance rates in hypervirulent Klebsiella pneumoniae strains: A systematic review and meta-analysis

IF 3.7 3区 医学 Q2 INFECTIOUS DISEASES Journal of global antimicrobial resistance Pub Date : 2024-09-01 DOI:10.1016/j.jgar.2024.06.018
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Abstract

Objectives

In response to the growing global concerns regarding antibiotic resistance, we conducted a meta-analysis to assess the prevalence of antibiotic resistance in hypervirulent Klebsiella pneumoniae (hvKp) strains.

Methods

We conducted a meta-analysis of antibiotic resistance in the hvKp strains. Eligible studies published in English until April 10, 2023, were identified through a systematic search of various databases. After removing duplicates, two authors independently assessed and analysed the relevant publications, and a third author resolved any discrepancies. Data extraction included publication details and key information on antibiotic resistance. Data synthesis employed a random-effects model to account for heterogeneity, and various statistical analyses were conducted using R and the metafor package.

Results

This meta-analysis of 77 studies from 17 countries revealed the prevalence of antibiotic resistance in hvKp strains. A high resistance rates have been observed against various classes of antibiotics. Ampicillin-sulbactam faced 45.3% resistance, respectively, rendering them largely ineffective. The first-generation cephalosporin cefazolin exhibited a resistance rate of 38.1%, whereas second-generation cefuroxime displayed 26.7% resistance. Third-generation cephalosporins, cefotaxime (65.8%) and ceftazidime (57.1%), and fourth-generation cephalosporins, cefepime (51.3%), showed substantial resistance. The last resort carbapenems, imipenem (45.7%), meropenem (51.0%) and ertapenem (40.6%), were not spared.

Conclusion

This study emphasizes the growing issue of antibiotic resistance in hvKp strains, with notable resistance to both older and newer antibiotics, increasing resistance over time, regional disparities and methodological variations. Effective responses should involve international cooperation, standardized testing and tailored regional interventions.

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高病毒性肺炎克雷伯菌株的抗生素耐药率:系统综述和荟萃分析。
研究目的针对全球日益关注的抗生素耐药性问题,我们进行了一项荟萃分析,以评估高病毒性肺炎克雷伯氏菌(hvKp)菌株的抗生素耐药性流行率:我们对 hvKp 菌株的抗生素耐药性进行了荟萃分析。通过对各种数据库进行系统检索,确定了 2023 年 4 月 10 日前发表的符合条件的英文研究。在去除重复内容后,两位作者独立评估并分析了相关出版物,第三位作者负责解决任何不一致之处。数据提取包括出版物详细信息和抗生素耐药性的关键信息。数据综合采用了随机效应模型来考虑异质性,并使用 R 和 metafor 软件包进行了各种统计分析:这项对来自 17 个国家的 77 项研究进行的荟萃分析揭示了 hvKp 菌株的抗生素耐药性流行情况。研究发现,hvKp菌株对各类抗生素的耐药率都很高。氨苄西林-舒巴坦的耐药率分别为 45.3%,使其基本失效。第一代头孢菌素头孢唑啉的耐药率为 38.1%,而第二代头孢呋辛的耐药率为 26.7%。第三代头孢菌素头孢他啶(65.8%)和头孢唑肟(57.1%)以及第四代头孢菌素头孢吡肟(51.3%)也出现了大量耐药性。最后一种碳青霉烯类药物亚胺培南(45.7%)、美罗培南(51.0%)和厄他培南(40.6%)也未能幸免。结论:本研究强调了 hvKp 菌株对抗生素的耐药性问题日益严重,对新旧抗生素都有明显的耐药性,耐药性随着时间的推移而增加,存在地区差异和方法差异。有效应对措施应包括国际合作、标准化测试和有针对性的地区干预。
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
Journal of global antimicrobial resistance
Journal of global antimicrobial resistance INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY
CiteScore
8.70
自引率
2.20%
发文量
285
审稿时长
34 weeks
期刊介绍: The Journal of Global Antimicrobial Resistance (JGAR) is a quarterly online journal run by an international Editorial Board that focuses on the global spread of antibiotic-resistant microbes. JGAR is a dedicated journal for all professionals working in research, health care, the environment and animal infection control, aiming to track the resistance threat worldwide and provides a single voice devoted to antimicrobial resistance (AMR). Featuring peer-reviewed and up to date research articles, reviews, short notes and hot topics JGAR covers the key topics related to antibacterial, antiviral, antifungal and antiparasitic resistance.
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