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Table 1 Baseline characteristics of included studies

From: Burden of carbapenem non-susceptible infections in high-risk patients: systematic literature review and meta-analysis

Author, year (PMID)

Country (funding source)

Setting of care

N

(CR n)

Patient type (high-risk type)

Pathogen species

Age (SD/IQR)

Male (%)

Co-morbidity score

Transplant (%);

diabetes (%); immunosuppression (%); renal disease (%)

Mortality (% CR; % comparator)

Other outcomes reported

Alicino 2015 (26464061)

[22]

Italy (none)

Tertiary teaching hospital

489

(327)

Critical carea population (NR)

K. pneumoniae

Median 68 (IQR 57–76)

66.2

NR

NR; NR; NR; NR

30-day

(36; 23.5)

NA

Brizendine 2015 (25385105)

[13]

US (NR)

Tertiary teaching hospital

108

(22)

Totally high-risk (transplant)

K. pneumoniae, ESBL-K. pneumoniae

Mean 53 (±12.1)

39

NR

100; NR; 100; NR

In-hospital

(18; 2)

NA

Capone 2013 (23137235)

[23]

Italy (gov.)

Tertiary teaching hospitals (one long-term facility)

97

(97)

Partially high-risk (44.3% SOT, corticosteroid therapy, immunodeficiency)

K. pneumoniae

Median 69 (IQR 50–77)

61.9

Charlson comorbidity index: median 5 (IQR 3–8); APACHE II: median 15 (IQR 12–20)

NR; 35; 44.3; 28.9 (CKD)

In-hospital (27.5; NA)

NA

Clancy 2013 (24011185)

[24]

US (acad., gov.)

Tertiary teaching hospital

17

(17)

Totally high-risk (transplant)

K. pneumoniae

Median 51 (IQR 25–70)

59

APACHE II: median 18 (IQR 4–26)

100; NR; 100; 58.8

30-day (18; NA); 90-day (47; NA)

AE

Cristina 2018 (28668656)

[25]

Italy (none)

Tertiary hospitals

213 (213)

Partially high-risk (14% solid malignancy, 8.5% HM, 3.3% SOT)

K. pneumoniae

Median 72 (IQR 61–78)

65.3

Charlson comorbidity index: median 2 (IQR 1–3)

3.29; 8.92; NR; 9.86 (chronic renal failure)

15-day (26.3; NA)

NA

Giannella 2018 (28842283)

[26]

Italy (none)

Tertiary teaching hospital

595

(595)

Partially high-risk (16% chemotherapy)

K. pneumoniae

Median 66 (IQR 54–76)

62

Charlson comorbidity index: 3; APACHE III: 20

NR; NR; NR; 17.6 (chronic renal failure), 12.3 (hemodialysis)

14-day (21.3; NA); in-hospital (29.6; NA)

NA

Gomez-Simmonds 2015 (25878348)

[27]

US (none)

Tertiary teaching hospital

223

(29)

Partially high-risk (11% SOT)

K. pneumoniae

Median 62; > 65: 44%

57

Charlson comorbidity index ≥4: 30%; Pitt bacteremia ≥4: 31%

15; NR; NR; 5 (ESRD requiring chronic dialysis)

30-day (41.4; 20.6)

NA

Hauck 2016 (26850824)

[28]

US (acad., gov.)

Tertiary hospital

483

(260)

Partially high-risk (18% any malignancy)

K. pneumoniae

BSI: median 63 (IQR 54–78); pneumonia: median 68 (IQR 58–81); UTI: median 69 (IQR 57–82); control: median 71 (IQR 63–81)

42

Charlson comorbidity index: median 3 (IQR 2–5)

NR; 49.9; NR; 25.9 (renal failure [creatinine > 2 mg/dL upon admission])

In-hospital (BSI: 38; UTI: 7; pneumonia: 34; control: 9)

LOS

Hoxha 2016 (26319590)

[29]

Italy (none)

NR

98

(49)

Critical carea (2% transplant)

K. pneumoniae

CRKP: median 72; CSKP: median 74

65

Charlson comorbidity index ≥3: CRKP: 61%, CSKP: 59%

1; NR; 36; 16 (dialysis)

30-day (61; 20)

NA

Judd 2016 (27320901)

[30]

US (NR)

Tertiary hospital

382

(32)

Critical carea population (NR)

P. aeruginosa

Mean 67.2 (±14.2)

62.6

NR

NR; NR; NR; NR

In-hospital (28.1; 8.9)

Cost, LOS

Kalpoe 2012 (22467548)

[31]

US (NR)

Tertiary hospital

175

(14)

Totally high-risk (liver transplant)

K. pneumoniae

Median 55 (IQR 23–78)

81

MELD: median 21 (IQR 6–45)

100; 31; 2 (HIV); 6 (CKD)

1-year (71; 13.7)

NA

Mazza 2017 (28457370)

[32]

Italy (NR)

NR

310

(8)

Totally high-risk (liver transplant)

K. pneumoniae

Median 54 (IQR 18–68)

NR

NR

100; NR; 100; 85.5 (CRRT)

In-hospital (62.5; 30.4)

LOS, AE, mechanical ventilation

Messina 2016 (26686227)

[33]

US (gov., industry)

Tertiary hospital

287

(109)

Partially high-risk (12% any malignancy)

K. pneumoniae

Median 70 (IQR 58–81)

42

Charlson comorbidity index: median 3 (IQR 2–5); Pitt bacteremia score ≥ 4: 24%

NR; 53; 12 (malignancy); 22

NA

Readmission

Micozzi 2017 (28283020)

[34]

Italy (none)

Tertiary teaching hospital

22

(10)

Totally high-risk (HM)

K. pneumoniae

Median 51.5 (IQR 28–68)

35.7

NR

NR; NR; 100; NR

Mortality (71.4; NA)

NA

Nguyen 2010 (20356699)

[35]

US (NR)

Tertiary teaching hospital

48

(48)

Partially high-risk (42% SOT, 33% immunosuppression, 8% HIV)

K. pneumoniae

Median 60 (IQR 37–86)

67

mAPACHE II: median 19 (IQR 12–35)

42 (SOT); 35; 8 (HIV); 44 (CRRT/ hemodialysis)

30-day (42; NA)

NA

Pena 2012 (22155832)

[36]

Spain (gov.)

Tertiary hospital

632

(145)

Partially high-risk (25% immunosuppression, 85% solid malignancy, 15% HM, 1% HIV)

P. aeruginosa

Median 68 (IQR 55.5–77.5); SAPS II: mean 42.6 (±17.9)

69

Charlson comorbidity index: median 2 (IQR 1–4); SAPS II: mean 42.6 (±17.9); Pitt score ≥ 2: 43%

NR; 26; 25; 16

30-day (35; 27)

NA

Pereira 2015 (26136397)

[37]

US (none)

Tertiary teaching hospital

304

(20)

Totally high-risk (liver transplant)

K. pneumoniae

Median 58 (IQR 51–62)

67

NR

100; 34; 100; NR

1-year (45; 18)

NA

Pouch 2015 (26341757)

[38]

US (gov.)

Tertiary teaching hospital

100

(20)

Totally high-risk (kidney transplant)

K. pneumoniae

CRKP: median 57 (IQR 51–67); CSKP: median 54 (IQR 40–63)

42

NR

100; 27; NR; 88 (RRT), 8 (polycystic kidney disease), 100 (kidney transplant)

Mortality (30; 10)

AE

Qureshi 2014 (24637691)

[39]

US (gov.)

Tertiary hospital

133

(133)

Partially high-risk (33% transplant, 9% solid malignancy, 42% HIV)

K. pneumoniae

ASB: median 62 (IQR 20–91); UTI: median 51 (IQR 24–67)

37.1

Charlson comorbidity index: ASB: median 4 (IQR 0–13); UTI: median 2 (IQR 0–7)

33.3; 44.8; 41.9; 16.2 (moderate to severe)

30-day

(6; NA)

LOS, readmission

Salsano 2016 (27371609)

[40]

Italy (NR)

Tertiary teaching hospital

553

(32)

Totally high-risk (open-heart surgery)

K. pneumoniae

CRKP: median 74 (IQR 67–77); no CRKP: median 71 (IQR 63–77)

68.5

Charlson comorbidity index: CRKP: median 3 (IQR 1–4); no CRKP: median 1 (IQR 1–2)

NA; 23.5; 1.4 (history of immunosuppression); 16.3 (CKD)

30-day (18.8; NA); in-hospital (25; 6)

NA

Satlin 2013 (22916826)

[41]

US (found., gov.)

Tertiary teaching hospital

18

(18)

Totally high-risk (HM)

Mixed Enterobacteriaceae

Median 56 (IQR 24–77)

39

NR

33 (stem cell); NR; 100; NR

14-day (53; NA); in-hospital (56; NA)

Mechanical ventilation

Simkins 2014 (25092500)

[42]

US (NR)

Tertiary teaching hospital

52

(13)

Totally high-risk (kidney transplant)

K. pneumoniae

CRKP: mean 53 (±18); CSKP: mean 55 (±16)

CRKP: 54; CSKP: 36

NR

100 (kidney transplant); 62 CRKP, 67 CSKP; 100; 100

6-month (38.5; 0); 6.5-month (46; 0)

AE

Sotgiu 2018 (29621600)

[43]

Italy (none)

Tertiary teaching hospital

46

(46)

Partially high-risk (13% cancer)

K. pneumoniae

Mean 69.3 (±13.0)

67.4

NR

NR; 8.6; NR; 2.9 (chronic renal failure)

Mortality (52.3; NA)

NA

Tamma 2016 (28013264)

[44]

US (acad., found., gov.)

Tertiary teaching hospital

83

(83)

Partially high-risk (3.9% HM, 12% SOT, 22.9% chemotherapy, 2.4% HIV)

Mixed Enterobacteriaceae

CP-CRE: median 58 (IQR 48–68); non-CP-CRE: median 58 (IQR 43–62)

CP-CRE: 59; non-CP-CRE: 63

Pitt bacteremia ≥4: CP-CRE: 54%; non-CP-CRE: 39%

11 CP-CRE, 13 non-CP-CRE (SOT); 5 CP-CRE, 2 non-CP-CRE (HSCT); 32 CR-CRE, 13 non-CR-CRE; NR; 8 CP-CRE, 4 non-P-CRE (ESRD)

14-day (15.7; NA); 30-day (20.5; NA)

NA

Trecarichi 2016 (27428072)

[45]

Italy (NR)

Tertiary teaching hospitals

278

(161)

Totally high-risk (HM)

K. pneumoniae

Age > 54: 56.1%

54.3

NR

22.3 (HSCT); 12.6; 100; 4

21-day (52.2; 14.5)

NA

Varotti 2017 (28796391)

[46]

Italy (NR)

Tertiary teaching hospital

82

(26)

Totally high-risk (kidney transplant)

K. pneumoniae

CRKP: mean 59 (±13); CRKP-ve: mean 53 (±14)

CRKP: 81; CRKP-ve: 84

Clavien Dindo: CRKP: mean 2.4 (±1.5); CRKP-ve: mean 1.5 (±1.1)

100 (kidney transplant); NR; 100; 100 (kidney transplant)

Mortality (8; NA)

AE, LOS, readmission

  1. Acad. Academic, AE Adverse event, APACHE Acute Physiology and Chronic Health Evaluation, ASB Asymptomatic bacteriuria, BSI Bloodstream infection, CKD Chronic kidney disease, CP-CRE Carbapenemase-producing carbapenem-resistant Enterobacteriaceae, CR Carbapenem-resistant, CRKP Carbapenem-resistant Klebsiella pneumoniae, CRRT Continuous renal replacement therapy, ESBL Extended-spectrum beta-lactamase, ESRD End stage renal disease, Found. Foundation, Gov. Government, HIV Human immunodeficiency virus, HM Hematologic malignancies, HSCT Hematopoietic stem cell transplantation, IQR Interquartile range, K. pneumoniae Klebsiella pneumonia, LOS Length of stay, MELD Model for End-Stage Liver Disease, N Number, NA Not applicable, NR Not reported, P. aeruginosa Pseudomonas aeruginosa, RRT Renal replacement therapy, SAPS Simplified Acute Physiology, SD Standard deviation, SOT Solid organ transplant, US United States, UTI Urinary tract infection
  2. aMajority were critical care population
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Antimicrobial Resistance & Infection Control

ISSN: 2047-2994

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