{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T09:48:57Z","timestamp":1774000137468,"version":"3.50.1"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Carbapenem-resistant\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      (CRKP) infections are increasingly prevalent. This meta-analysis aimed to identify key risk factors to inform prevention strategies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We searched PubMed and Web of Science up to October 2025 for studies on CRKP infection risk factors. Study quality was assessed using the Newcastle-Ottawa Scale. We computed pooled odds ratios (ORs) with 95% confidence intervals (CIs) and evaluated heterogeneity using the\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      statistic and the\n                      <jats:italic>Q<\/jats:italic>\n                      -test, employing either fixed- or random-effects models as appropriate.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventeen studies (5,303 cases) were included. Prior hospitalization, APACHE II score, and diabetes were not associated with CRKP infection. Significant risk factors included ICU admission (OR\u202f=\u202f4.42, 95% CI: 2.82\u20136.91), cardiovascular disease (OR\u202f=\u202f4.52, 95% CI: 3.23\u20136.30), renal disease (OR\u202f=\u202f2.31, 95% CI: 1.74\u20133.06), multiple invasive procedures (e.g., mechanical ventilation OR\u202f=\u202f3.82, 95% CI: 2.46\u20135.92; urinary catheterization OR\u202f=\u202f4.73, 95% CI: 3.33\u20136.72), and exposure to various antimicrobial classes, notably carbapenems (OR\u202f=\u202f6.36, 95% CI: 5.16\u20137.83), and tetracyclines (OR\u202f=\u202f11.79, 95% CI: 7.75\u201317.93), though the latter\u2019s high magnitude may be influenced by the limited number of studies and potential confounding by indication. Subgroup analysis showed the risks from mechanical ventilation and urinary catheterization were significantly higher in developing versus developed countries (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.03 and\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.01, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ICU admission, specific comorbidities, invasive procedures, and broad antimicrobial exposure are key risk factors for CRKP infection. Enhanced aseptic techniques in developing countries are crucial to mitigate risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/<\/jats:ext-link>\n                      , CRD420251242025.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1773088","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T06:38:14Z","timestamp":1773988694000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors for carbapenem-resistant Klebsiella pneumoniae infection: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Zhenghaoyu","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Medical Technology, School of Gongli Hospital Medical Technology, University of Shanghai for Science and Technology","place":["Shanghai, China"]},{"name":"Department of Infectious Diseases, Gongli Hospital of Shanghai Pudong New Area","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Medical Technology, School of Gongli Hospital Medical Technology, University of Shanghai for Science and Technology","place":["Shanghai, China"]},{"name":"Department of Infectious Diseases, Gongli Hospital of Shanghai Pudong New Area","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yonghong","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Gongli Hospital of Shanghai Pudong New Area","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.jhin.2023.12.002","article-title":"Incidence and risk factors for subsequent infections among rectal carriers with carbapenem-resistant Klebsiella pneumoniae: a systematic review and meta-analysis","volume":"145","author":"Wang","year":"2024","journal-title":"J Hosp Infect"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1479","DOI":"10.1001\/jama.2015.12480","article-title":"Epidemiology of carbapenem-resistant Enterobacteriaceae in 7 US communities, 2012-2013","volume":"314","author":"Guh","year":"2015","journal-title":"JAMA"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e015365","DOI":"10.1136\/bmjopen-2016-015365","article-title":"EUropean prospective cohort study on Enterobacteriaceae showing REsistance to CArbapenems (EURECA): a protocol of a European multicentre observational study","volume":"7","author":"Guti\u00e9rrez-Guti\u00e9rrez","year":"2017","journal-title":"BMJ Open"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.ebiom.2017.04.032","article-title":"Nationwide surveillance of clinical carbapenem-resistant Enterobacteriaceae (CRE) strains in China","volume":"19","author":"Zhang","year":"2017","journal-title":"EBioMedicine"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"ofad649","DOI":"10.1093\/ofid\/ofad649","article-title":"The global and regional prevalence of hospital-acquired carbapenem-resistant Klebsiella pneumoniae infection: a systematic review and meta-analysis","volume":"11","author":"Lin","year":"2024","journal-title":"Open Forum Infect Dis"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e0324925","DOI":"10.1371\/journal.pone.0324925","article-title":"Risk factors for multidrug-resistant and carbapenem-resistant Klebsiella pneumoniae bloodstream 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Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e0047923","DOI":"10.1128\/msphere.00479-23","article-title":"The impact of three carbapenems at a single-day dose on intestinal colonization resistance against carbapenem-resistant Klebsiella pneumoniae","volume":"8","author":"Kuang","year":"2023","journal-title":"mSphere"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1128\/cmr.00001-07","article-title":"Carbapenemases: the versatile beta-lactamases","volume":"20","author":"Queenan","year":"2007","journal-title":"Clin Microbiol Rev"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"106090","DOI":"10.1016\/j.micpath.2023.106090","article-title":"Efficacy and safety of ceftazidime-avibactam compared to other antimicrobials for the treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae strains, a systematic review and meta-analysis","volume":"179","author":"Karampatakis","year":"2023","journal-title":"Microb 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