Clinical and molecular epidemiology of extended-spectrum beta-lactamase- Producing klebsiella spp: A systematic review and meta-Analyses

Healthcare-related infections caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella spp. are of major concern. To control transmission, deep understanding of the transmission mechanisms is needed. This systematic review aimed to identify risk factors and sources, clonal relatedness using molecular techniques, and the most effective control strategies for ESBL-producing Klebsiella spp. A systematic search of PubMed, Embase, and Outbreak Database was performed. We identified 2771 articles from November 25th, 1960 until April 7th, 2014 of which 148 were included in the systematic review and 23 in a random-effects meta-Analysis study. The random-effects meta-Analyses showed that underlying disease or condition (odds ratio [OR] = 6.25; 95% confidence interval [CI] = 2.85 to 13.66) generated the highest pooled estimate. ESBL-producing Klebsiella spp. were spread through person-To-person contact and via sources in the environment; we identified both monoclonal and polyclonal presence. Multi-faceted interventions are needed to prevent transmission of ESBL-producing Klebsiella spp

Clinical and Molecular Epidemiology of Extended-Spectrum Beta-Lactamase-Producing Klebsiella spp.: A Systematic Review and Meta-Analyses

Healthcare-related infections caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella spp. are of major concern. To control transmission, deep understanding of the transmission mechanisms is needed. This systematic review aimed to identify risk factors and sources, clonal relatedness using molecular techniques, and the most effective control strategies for ESBL-producing Klebsiella spp. A systematic search of PubMed, Embase, and Outbreak Database was performed. We identified 2771 articles from November 25th, 1960 until April 7th, 2014 of which 148 were included in the systematic review and 23 in a random-effects meta-analysis study. The random-effects meta-analyses showed that underlying disease or condition (odds ratio [OR] = 6.25; 95% confidence interval [CI] = 2.85 to 13.66) generated the highest pooled estimate. ESBL-producing Klebsiella spp. were spread through person-to-person contact and via sources in the environment; we identified both monoclonal and polyclonal presence. Multi-faceted interventions are needed to prevent transmission of ESBL-producing Klebsiella spp

Clinical and Molecular Epidemiology of Extended-Spectrum Beta-Lactamase-Producing <i>Klebsiella</i> spp.: A Systematic Review and Meta-Analyses

<div><p>Healthcare-related infections caused by extended-spectrum beta-lactamase (ESBL)-producing <i>Klebsiella</i> spp. are of major concern. To control transmission, deep understanding of the transmission mechanisms is needed. This systematic review aimed to identify risk factors and sources, clonal relatedness using molecular techniques, and the most effective control strategies for ESBL-producing <i>Klebsiella</i> spp. A systematic search of PubMed, Embase, and Outbreak Database was performed. We identified 2771 articles from November 25th, 1960 until April 7th, 2014 of which 148 were included in the systematic review and 23 in a random-effects meta-analysis study. The random-effects meta-analyses showed that underlying disease or condition (odds ratio [OR] = 6.25; 95% confidence interval [CI] = 2.85 to 13.66) generated the highest pooled estimate. ESBL-producing <i>Klebsiella</i> spp. were spread through person-to-person contact and via sources in the environment; we identified both monoclonal and polyclonal presence. Multi-faceted interventions are needed to prevent transmission of ESBL-producing <i>Klebsiella</i> spp.</p></div

Flow diagram of study selection for the systematic review and random-effects meta-analyses on extended-spectrum beta-lactamase-producing <i>Klebsiella</i> spp.

<p>¹ Number of studies included in the review comprise the sources and reservoirs, associated factors, cluster analysis and successful interventions. ² No response was obtained from the first and/or corresponding authors for the requested article.</p

Associated protective factors for the presence of ESBL-producing <i>Klebsiella</i> spp. based on multivariate analyses.

<p>Abbreviations: RE, risk estimate; HR, hazard ratio; OR, odds ratio.</p><p>^a This factor was classified in the category of prior antibiotic exposure for a random-effects meta-analysis study.</p><p>^b This category was not included in a random-effects meta-analysis study.</p><p>^c This factor was classified in the category of patient characteristics for a random-effects meta-analysis study.</p><p>Associated protective factors for the presence of ESBL-producing <i>Klebsiella</i> spp. based on multivariate analyses.</p

Associated risk factors for the presence of ESBL-producing <i>Klebsiella</i> spp. based on multivariate analyses.

<p>Abbreviations: RE, risk estimate, ^2x, ^3x, ^4x or ^6x, two, three, four or six different factors per reference.</p><p>^a Bloodstream infections.</p><p>^b This category was not included in a random-effects meta-analysis study.</p><p>Associated risk factors for the presence of ESBL-producing <i>Klebsiella</i> spp. based on multivariate analyses.</p

Forest plots of random-effects meta-analyses: individual and pooled odds ratios for associated risk factors and associated protective factors for presence of ESBL-producing Klebsiella spp. among patients in hospitals.

<p>* Bloodstream infections</p

Environmental sources and reservoirs for ESBL-producing <i>Klebsiella</i> spp., identified from <i>n</i> = 57 studies.

<p>^a This study proved the source or reservoir with use of a molecular typing technique.</p><p>Environmental sources and reservoirs for ESBL-producing <i>Klebsiella</i> spp., identified from <i>n</i> = 57 studies.</p

Top 10 strategies to control ESBL-producing <i>Klebsiella</i> spp. outbreaks in hospitals.

<p>^a The study added this additional intervention that was successful to control the events of ESBL-producing <i>Klebsiella</i> spp. in the hospital.</p><p>Top 10 strategies to control ESBL-producing <i>Klebsiella</i> spp. outbreaks in hospitals.</p

Random-effects meta-analyses of the different associated risk factors and associated protective factors for the presence of ESBL-producing <i>Klebsiella</i> spp. among patients in hospitals.

<p>Abbreviations: OR, odds ratio; CI, confidence interval; NC, not calculated because there were too few strata.</p><p>^a Only studies included that reported 95% CI and <i>P</i> values</p><p>Random-effects meta-analyses of the different associated risk factors and associated protective factors for the presence of ESBL-producing <i>Klebsiella</i> spp. among patients in hospitals.</p