Background Studies on risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) infection have provided inconsistent results, partly due to the choice of the control group. We conducted a systematic review and meta-analysis to assess the risk factors for CRKP infection by comparing CRKP-infected patients with two types of controls: patients infected with carbapenem-susceptible Klebsiella pneumoniae (comparison 1) or patients not infected with CRKP (comparison 2). Methods Data on potentially relevant risk factors for CRKP infection were extracted from studies indexed in PubMed, EMBASE, Web of Science or EBSCO databases from January 1996 to April 2019, and meta-analyzed based on the outcomes for each type of comparison. Results The meta-analysis included 18 studies for comparison 1 and 14 studies for comparison 2. The following eight risk factors were common to both comparisons: admission to intensive care unit (ICU; odds ratio, ORcomparison 1 = 3.20, ORcomparison 2 = 4.44), central venous catheter use (2.62, 3.85), mechanical ventilation (2.70, 4.78), tracheostomy (2.11, 8.48), urinary catheter use (1.99, 0.27), prior use of antibiotic (6.07, 1.61), exposure to carbapenems (4.16, 3.84) and exposure to aminoglycosides (1.85, 1.80). Another 10 risk factors were unique to comparison 1: longer length of hospital stay (OR = 15.28); prior hospitalization (within the previous 6 months) (OR = 1.91); renal dysfunction (OR = 2.17); neurological disorders (OR = 1.52); nasogastric tube use (OR = 2.62); dialysis (OR = 3.56); and exposure to quinolones (OR = 2.11), fluoroquinolones (OR = 2.03), glycopeptides (OR = 3.70) and vancomycin (OR = 2.82). Conclusions Eighteen factors may increase the risk of carbapenem resistance in K. pneumoniae infection; eight factors may be associated with both K. pneumoniae infections in general and CRKP in particular. The eight shared factors are likely to be ‘true’ risk factors for CRKP infection. Evaluation of risk factors in different situations may be helpful for empirical treatment and prevention of CRKP infections.

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Available evidence suggests that prior central venous or urinary catheterization, mechanical ventilation, and nasogastric tube use are associated with a higher risk of A. baumannii nosocomial bacteremia in the ICU.

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Urinary tract infections (UTIs) are among the most frequent causes for antibiotic prescription and; therefore, alternative treatment options for UTIs can potentially reduce antibiotic usage and development of resistance. To evaluate the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDS) for the treatment of uncomplicated lower UTIs in women, this study implemented a meta-analytic approach to evaluate the results of available randomized clinical studies from online databases. A total of four trials involving 1144 patients with uncomplicated lower UTIs were included in the final evaluation. Results showed that symptom resolution at Day 3–4 in the NSAIDs group was significantly lower than that in the antibiotics group [pooled odds ratio (OR) = 0.41, 95% confidence interval (CI): 0.23–0.74, P < 0.05]. However, there was no significant difference between the NSAIDs and antibiotics groups in symptom resolution at Day 7 (pooled OR = 0.43, 95% CI: 0.17–1.06, P = 0.07), secondary antibiotic treatment rate at Day 28–30 (pooled OR = 1.15, 95% CI: 0.16–7.98, P = 0.89) and adverse events rate (pooled OR = 1.09, 95% CI: 0.61–1.96, P = 0.77). Therefore, this meta-analysis suggests that, although inferior to antibiotics in fast symptom resolution, symptomatic treatment with NSAIDs can be considered as an alternative treatment option for uncomplicated lower UTIs in women. However, given the low number of randomized controlled trials that met inclusion criteria in this meta-analysis, efficacy of NSAIDs for treatment of uncomplicated lower UTIs should be further evaluated in more comprehensive clinical studies.

Background: Secondary bacterial pneumonia is an important complication of seasonal influenza, but little data is available about impact on death and risk factors. This study identified risk factors for all-cause in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza. Methods: A retrospective cohort study was performed at a tertiary teaching hospital in southwest China. The study cohort included all adult hospitalized patients with a laboratory-confirmed, community-acquired influenza virus infection during three consecutive influenza seasons from 2017 to 2020. Cause-specific Cox regression was used to analyze risk factors for mortality and secondary bacterial pneumonia, respectively, accounting for competing events (discharge alive and discharge alive or death without secondary bacterial pneumonia, respectively). Results: Among 174 patients enrolled in this study, 14.4% developed secondary bacterial pneumonia and 11.5% died during hospitalization. For all-cause in-hospital mortality, time-varying secondary bacterial pneumonia was a direct risk factor of death (cause-specific hazard ratio [csHR] 3.38, 95% confidence interval [CI] 1.25-9.17); underlying disease indirectly increased death risk through decreasing the hazard of being discharged alive (csHR 0.55, 95% CI 0.39-0.77). For secondary bacterial pneumonia, the final model only confirmed direct risk factors: age ≥65 years (csHR 2.90, 95% CI 1.27-6.62), male gender (csHR 3.78, 95% CI 1.12-12.84) and mechanical ventilation on admission (csHR 2.96, 95% CI 1.32-6.64). Conclusions: Secondary bacterial pneumonia was a major risk factor for in-hospital mortality among adult hospitalized patients with community-acquired influenza. Prevention strategies for secondary bacterial pneumonia should target elderly male patients and critically ill patients under mechanical ventilation.

We describe a case of infective endocarditis (IE) caused by Granulicatella adiacens in a patient who had fever for 4 months before admission. He had a complex medical history of active hyperthyroidism and schizophrenia, which might have misled the clinician in ignoring the existence of a serious infection like IE. A history of splenectomy and the likelihood of congenital cardiac valve deficiency were the possible underlying risk factors. His persistent leukocytosis perplexed our judgement in terms of resolution of infection and treatment efficacy, which was probably due to his splenectomy. C-reactive protein was the alternative laboratory indicator. Clinical and Laboratory Standards Institute criteria have not been established for the fastidious G. adiacens. Therefore, we referred to the viridans group streptococci and literature to evaluate antimicrobial susceptibility testing. We suggest that teicoplanin combined with ceftriaxone could serve as an effective therapy for IE caused by G. adiacens.

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