OBJECTIVES: This study aimed to identify the prevalence and risk profile of emerging multidrug resistance (MDR) in Klebsiella pneumoniae/ Enterobacteriaceae w.r.t controls.

METHODS: An exhaustive search was conducted in PubMed/MEDLINE and OVID/Embase for prospective or retrospective cohort and case-control studies addressing risk factors for MDRKP/Enterobacteriaceae infection. Studies published in the English language were included whereas studies involving animal models were excluded. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies. An odds ratio of developing MDRKP infection was pooled using fixed-effect and random-effect models based on heterogeneity. The Eggers test and funnel plots were used to assess publication bias. In addition, sensitivity analysis was conducted to assess the reliability of the evidence. This meta-analysis is registered on the PROSPERO database (CRD42022311487).

RESULTS: The pooled prevalence estimate of MDR-KP infection was found to be 22.3%. The results were based on 11 studies with 3292 participants (736 cases, 2556 controls). Nearly half of the studies (5/11) were conducted in the European region. A total of 16 risk factors were identified, most evident were diabetes mellitus [OR 1.28, 95% CI 0.99-1.64], use of central-venous catheter [OR 1.69, 95% CI 1.15-2.48], cephalosporin use [OR 2.35, 95% CI 0.72-7.63], immunocompromised state [OR 1.47, 95% CI 1.09-2], use of mechanical ventilation [OR 1.58, 95% CI 1.26-1.96] and male gender [OR 1.03, 95% CI 0.78- 1.37]. The NOS identified 4 high-quality and 7 medium-quality studies.

CONCLUSIONS: MDRKP infections were found to be more prevalent and 16 risk factors were reported that might increase the risk of developing MDRKP infections. Monitoring risk profiles is therefore suggested for effective infection control. More well-designed studies are needed to increase the sample size and, consequently, the reliability of the model.