Resistance of different antimicrobials to CRKP: a meta analysis.

OBJECTIVE

This meta-analysis aimed to systematically compare the resistance rates of penicillins, cephalosporins, and carbapenems between carbapenem-resistant Klebsiella pneumoniae (CRKP) and carbapenem-susceptible K. pneumoniae (CSKP) isolates, in order to provide an evidence-based reference for clinical practice.

METHODS

A systematic literature search was conducted in CNKI, Wanfang, VIP, PubMed, Wiley, and Web of Science databases for studies published from inception to November 2024. Thirteen studies involving 4,883 patients were included. The primary outcome was the resistance rate. Data were pooled using RevMan 5.3 software. Heterogeneity was assessed using the I² statistic, and effect sizes were calculated as risk ratios (RR) with 95% confidence intervals (CIs) using random- or fixed-effects models. Publication bias was evaluated using funnel plots and Egger’s test.

RESULTS

The pooled analysis revealed that CRKP exhibited significantly higher resistance rates than CSKP to penicillins (RR = 2.74, 95% CI: 1.16–4.32), cephalosporins (ceftazidime: RR = 2.71, 95% CI: 0.89–4.52; cefepime: RR = 2.46, 95% CI: 1.03–3.88; cefuroxime: RR = 3.06, 95% CI: 1.36–4.75), and carbapenems (imipenem: RR = 5.52, 95% CI: 2.59–8.45; meropenem: RR = 5.33, 95% CI: 1.88–8.77).

CONCLUSION

CRKP demonstrates significantly higher resistance to β-lactam antibiotics, including penicillins, cephalosporins, and carbapenems, compared to CSKP. These findings underscore the necessity for enhanced resistance monitoring of CRKP infections and the exploration of novel therapeutic strategies. Future studies are warranted to validate these findings and to establish clearer clinical guidelines. CLINICAL TRIAL: Not applicable.