Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infection: A Meta-Analysis

Aims: Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection has been rapidly emerging as a life-threatening nosocomial disease in many countries. However, studies on the corresponding risk factors of CRKP infection showed inconsistent results. To resolve these inconsistencies, we conducted a meta-analysis of previous studies on the potential risk factors of CRKP infection. The results of this study could be used to develop CRKP infection prevention strategies. Methods: Relevant works were systematically searched from five electronic databases up to September 2016. Z-test was used to determine the significance of the pooled odds ratios (ORs). ORs and 95% confidence intervals were utilized to compare the risk factors of CRKP infection. Results: Sixteen studies that involved 3,627 participants were included in the meta-analysis. We identified the following risk factors that were associated with CRKP infection: (1) longer length of hospital stay (LOS) (OR=12.92), (2) admission to intensive care unit (ICU) (OR=2.48), (3) prior hospitalization (OR=1.85), (4) longer days of ICU stay (OR=4.58), (5) transplant recipient (OR=2.01), (6) steroid use (OR=1.43), (7) central venous catheter use (OR=2.30), (8) mechanical ventilation (OR=2.54), (9) presence of tracheostomy (OR=3.63), (10) parenteral nutrition (OR=2.38), (11) previous antibiotic use (OR=3.31), and (12) exposure to carbapenems (OR=4.01), (13) aminoglycosides (OR=2.05), (14) glycopeptides (OR=2.40), (15) quinolones (OR=2.28), and (16) anti-pseudomonal penicillins (OR=2.67). Conclusions: Sixteen risk factors including longer LOS, admission to ICU, previous antibiotic use, and exposure to carbapenems were associated with the development of CRKP infection. Identification of modifiable risk factors could play an important role in the prevention of CRKP infection.