Risk factors for carbapenem-resistant Klebsiella pneumoniae infection in hospitalized patients: a meta-analysis

Background: Healthcare-associated infections due to carbapenem-resistant Klebsiella pneumoniae (CRKP) are a global public health threat with rising hospital morbidity and mortality. We conducted a meta-analysis to systematically identify CRKP infection risk factors. Methods: We searched Medline, Embase, Web of Science, and Cochrane Library for studies published January 1991-December 2024. Pooled odds ratio (OR)/95% confidence intervals (CIs) were used to assess risk factors; publication bias was evaluated via funnel plots and Egger's test, and robustness via leave-one-out sensitivity analysis. Results: Fifty-one studies (13,860 patients: 4,711 CRKP cases, 9,149 carbapenem-susceptible K. pneumoniae controls) were included, with 43 reported risk factors. Thirty-one were significant: demographic/underlying diseases [male sex (OR = 1.31), kidney diseases (OR = 1.47), respiratory system diseases (OR = 2.69), cardiovascular diseases (OR = 1.34)]; invasive procedures [endoscopy (OR = 4.08), tracheal cannula (OR = 3.72), mechanical ventilation (OR = 3.61)]; medical environment [ICU admission (OR = 4.27), pre-infection hospital stay (mean difference=14.98 days)]; antibiotics [tigecycline (OR = 5.97), carbapenems (OR = 4.79), which may reflect disease severity, prior colonization]. Subgroup analysis showed regional heterogeneity: Western populations had higher risks with cephalosporins (OR = 2.68 vs. Eastern 1.55) and fluoroquinolones (OR = 3.58 vs. Eastern 1.89), while Eastern populations had higher risks with invasive procedures (dialysis: OR = 4.47 vs. Western 2.03). Sensitivity analysis confirmed robust results. Conclusions: This meta-analysis reports endoscopy and surgical drainage as distinct subtypes of invasive procedural factors associated with hospital-acquired CRKP infection and describes regional differences in associated factors between Eastern and Western populations. These findings, based on observational evidence, provide preliminary insights for targeted prevention strategies. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024628428.