Antimicrobial resistance in hypermucoviscous and non-hypermucoviscous Klebsiella pneumoniae: a systematic review and meta-analysis

Antimicrobial resistance has recently increased due to emerging carbapenem-resistant Klebsiella pneumoniae and extended-spectrum β-lactamase (ESBL)-producing strains of K. pneumoniae, especially among hypermucoviscous K. pneumoniae (hmKp) strains. To evaluate the prevalence of ESBL-producing and carbapenem-resistant strains in hmKp and non-hmKp clinical isolates through a systematic review and meta-analysis, Osaka Metropolitan University researchers searched PubMed, Scopus, and Cochrane Library databases from January 2000 to June 2023.

Clinical and in vivo/in vitro studies involving confirmed K. pneumoniae clinical isolates differentiated into hmKp and non-hmKp strains based on string test results. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated based on the number of individuals in each target group. Forest plots were used to visualize the effect sizes and 95% CIs of individual studies estimated using the inverse variance and DerSimonian – Laird methods with fixed – and random-effects models, respectively. Heterogeneity was assessed using Cochran’s Q test (I² ≥ 50%). Fifteen studies comprising 2,049 clinical isolates of K. pneumoniae met the inclusion criteria.

Meta-analysis revealed that hmKp strains were associated with a significantly lower prevalence of ESBL-producing strains (pooled OR: 0.26, 95% CI: 0.11–0.63, P = 0.003) and a slightly lower prevalence of carbapenem-resistant strains than non-hmKp strains (pooled OR: 0.63, 95% CI: 0.40–0.97, P = 0.038). hmKp strains exhibited lower and slightly lower prevalence of ESBL production and carbapenem resistance, respectively, than non-hmKp strains.

However, given the rising prevalence of ESBL-producing and carbapenem-resistant hmKp strains, patients infected by string-test-positive K. pneumoniae must be managed prudently, considering the potential for highly resistant strains.

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