Prevalence, mortality, risk factors, and treatment of carbapenem-resistant hypervirulent Klebsiella pneumoniae: an evidence map.

Purpose

Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) is a critical global health threat due to its hypervirulence and multidrug resistance, causing severe, high-mortality infections. This study systematically reviews its epidemiology, risk factors, treatment strategies, and activity.

Methods

We searched databases to identify studies reporting CR-hvKP prevalence, resistance profiles, risk factors, treatment strategies, and activity. Two reviewers independently extracted data; a third resolved discrepancies. Results were summarized descriptively.

Results

Forty-three studies involving 9283 carbapenem-resistant K. pneumoniae (CRKP) strains were included. The median prevalence of CR-hvKP among CRKP was 9.40% (IQR 4.40-14.80%) via the string test plus virulence assay. Diabetes (OR = 10.947, P = 0.010) and ICU admission (OR = 16.012, P = 0.003) were independent risk factors for CR-hvKP infection. Among 130 patients, the most commonly used antibiotics included meropenem (34.62%), cefoperazone-sulbactam (31.54%), and tigecycline (28.46%). However, treatment failure remains a significant concern. Antimicrobial resistance analysis indicated that CR-hvKP exhibited high resistance rates to cephalosporins (> 80%) and quinolones (45-100%). One study found high susceptibility (92.50-100.00%) to nitrofurantoin, polymyxins, imipenem-relebactam, tigecycline, and colistin. Mortality analysis revealed a median mortality rate of 30.30% (IQR 13.33-53.06%).

Conclusion

CR-hvKP remains a formidable public health threat due to its substantial prevalence, elevated mortality, and multidrug resistance. Current therapeutic strategies lack standardization, and widely applied combination therapy has inconsistent efficacy. Further research is urgently needed to optimize treatment regimens. Early detection, precise antimicrobial stewardship, and stringent infection control measures are crucial to mitigate the spread and impact of CR-hvKP.