A systematic review and meta-analysis of treatment outcomes following antibiotic therapy among patients with carbapenem-resistant Klebsiella pneumoniae infections

Agyeman, Akosua Adom; Bergen, Phillip J.; Rao, Gauri G.; Nation, Roger L.; Landersdorfer, Cornelia B.

doi:10.1016/j.ijantimicag.2019.10.014

Cited by 86 publications

(66 citation statements)

References 15 publications

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“…The 30-day mortality rate was 33.07% in our study. In accordance with our results, Agyeman AA et al reported that the pooled mortality was 37.2% in their meta-analysis which involved 54 studies and 3,195 CRKP-infected patients; and Lemos EV reported 850 deaths (33%) among 2,546 CRAB-infected patients in their meta-analysis including 16 observational studies (Lemos et al, 2014;Agyeman et al, 2020). In our study, univariate analyses showed that some clinical and laboratory variables were related to outcomes of CRO-infected patients.…”

Section: Discussionsupporting

confidence: 91%

“…Due to rapidly mobile genetic elements and limited effective treatment strategies, carbapenem resistance transmit between manifold gram-negative bacteria and adversely affect patients' clinical outcomes, resulted in significant morbidity and mortality (Falagas et al, 2014 ; Lemos et al, 2014 ; Zhang et al, 2016 ; Tamma et al, 2017 ; Agyeman et al, 2020 ). CROs have caused several outbreaks and become a global public health issue (Yu et al, 2017 ; Ben-Chetrit et al, 2018 ; Gu et al, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

“…CROs have been highlighted as critical pathogens in the World Health Organization (WHO) prioritization of pathogens (World Health Organization, 2017 ). Due to multiple and high levels of antimicrobial resistance, these bacteria have limited therapeutic options in clinical and resulted in an increased risk of mortality in patients (Falagas et al, 2014 ; Lemos et al, 2014 ; Zhang et al, 2016 ; Agyeman et al, 2020 ). To identify those at high risk of poor prognosis, it is important to develop effective predictive tools, which may promote a shift from empirical treatment to precision-guided therapy tailored to each patient with expected improved patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Effect of Host Immunity on Predicting the Mortality of Carbapenem-Resistant Organism Infection

Lin

Wang

Luo

et al. 2020

Front. Cell. Infect. Microbiol.

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Carbapenem-resistant organisms (CROs) are associated with considerable mortality clinically. There is a lack of effective tool to predict individual prognosis. We aim to determine if host immunity can be utilized to predict the prognosis of patients infected with CRO. From December 2018 to August 2019, we recruited CRO-infected patients to evaluate risk factors for 30-day mortality. Clinical, routine laboratory, immune and microbiological features were investigated and subjected to univariate and multivariate analyses. The final predictive models were established based on the regression coefficients of multivariate logistic regression. A total of 127 CRO-infected patients were enrolled in our study, including 85 survivors and 42 non-survivors. The number and IFNγ producing ability of lymphocytes were remarkably decreased in non-survivors. The number of IFN-γ + CD4 + T cells could effectively predict 30-day mortality of CRO infection. Its area under the receiver operating characteristic (ROC) curve, sensitivity, specificity and accuracy, were 0.889 (95% confidence interval [CI], 0.834-0.945), 81.0, 80.0, and 80.3%, respectively. In multivariate analysis of laboratory parameters, IFN-γ + CD4 + T cell number and creatinine concentration were selected for the 2-marker model to predict prognosis fleetly. Its area under the ROC curve, sensitivity, specificity and accuracy were 0.894 (95% CI, 0.841-0.947), 83.3, 82.4, and 82.7%, respectively. Impaired lymphocyte function was an important factor to affect the outcome of CRO-infected patients. A 2-marker model based on the combination of IFN-γ + CD4 + T cell number and creatinine showed good performance in predicting the prognosis of CRO infection.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effect of Host Immunity on Predicting the Mortality of Carbapenem-Resistant Organism Infection

Lin

Wang

Luo

et al. 2020

Front. Cell. Infect. Microbiol.

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“…2 However, with the indiscriminate use of antibiotics, infection caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) is becoming an increasingly serious global problem that is associated with significant morbidity and mortality. 3 CRKP are known to be resistant to multiple antibiotic classes. Presently, only a few drugs such as polymyxins, tigecycline, aminoglycosides, fosfomycin, ceftazidime-avibatan, imipenemcilastatin-relebactam, and meropenem-vaborbactam exhibit favorable in-vitro activity against CPKP.…”

Section: Introductionmentioning

confidence: 99%

“…New drug development is an extensive process, and a study has shown that combination therapy is associated with lower mortality rather than monotherapy among antibiotic-treated CRKP-infected patients. 3 Hence, we screened combinations of antibiotics to study the antibacterial activity against clinical isolates of CRKP in-vitro and provide real-time drug susceptibility results to optimize the antimicrobial therapy for CRKP-infected patients. In our study, antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method, and the results were expressed as susceptible, intermediate, or resistant according to Clinical and Laboratory Standards Institute (CLSI) guidelines.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the Clinical Effect of Combined Drug Susceptibility to Guide Medication for Carbapenem-Resistant Klebsiella pneumoniae Patients Based on the Kirby–Bauer Disk Diffusion Method

Yao

Liu

Jiang

et al. 2021

IDR

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An All‐in‐One Nano‐Biomimetic Polyamidoamine Dendrimer Platform for Treatment of CRKP Pneumonia

Duan,

Li,

Wang

et al. 2024

Adv Funct Materials

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Polymyxin B (PMB) is often considered as the last line of defense for treating carbapenem‐resistant Klebsiella pneumoniae (CRKP). However, its efficacy is hindered by limited penetration across the blood‐air barrier in the lung due to its low lipid solubility. To simultaneously increase PMB in epithelial lining fluid while suppressing the excessive inflammatory response in the lung, a novel nano‐biomimetic system “Siv‐PMB@G4@MM” is designed and fabricated by encapsulating PMB‐ and anti‐inflammatory Sivelestat (Siv)‐loaded G4 PAMAM dendrimers with macrophage membranes (MM). The Siv‐PMB@G4@MM displayed a superior acidic pH‐responsive release property and can target inflamed lung tissues, greatly increasing the concentrations of PMB and Siv at the infection site. Compared with free drugs, Siv‐PMB@G4@MM demonstrated superior synergistic antibacterial and anti‐inflammatory activities. Moreover, due to the ability of MM to sequester lipopolysaccharide (LPS) and some pro‐inflammatory cytokines, Siv‐PMB@G4@MM further enhanced the anti‐inflammatory potential of Siv. In mouse models of LPS‐induced acute lung injury, pulmonary bacterial infection, and sepsis‐induced pneumonia, Siv‐PMB@G4@MM significantly reduced inflammatory responses and/or bacterial burdens, mitigated neutrophil infiltration and pulmonary edema, and decreased neutrophil extracellular trap (NET) secretion. The highly improved biocompatibility and efficiency of the multifunctional Siv‐PMB@G4@MM presents a promising strategy for the clinical treatment of antibiotic‐resistant bacterial pneumonia.

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A systematic review and meta-analysis of treatment outcomes following antibiotic therapy among patients with carbapenem-resistant Klebsiella pneumoniae infections

Cited by 86 publications

References 15 publications

The Effect of Host Immunity on Predicting the Mortality of Carbapenem-Resistant Organism Infection

The Effect of Host Immunity on Predicting the Mortality of Carbapenem-Resistant Organism Infection

Analysis of the Clinical Effect of Combined Drug Susceptibility to Guide Medication for Carbapenem-Resistant Klebsiella pneumoniae Patients Based on the Kirby–Bauer Disk Diffusion Method

An All‐in‐One Nano‐Biomimetic Polyamidoamine Dendrimer Platform for Treatment of CRKP Pneumonia

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