Table 1.
Baseline characteristics of included studies
| Author, year (PMID) | Country (funding source) | Setting of care | N (CR n) |
Patient type (high-risk type) | Pathogen species | Age (SD/IQR) | Male (%) | Co-morbidity score | Transplant (%); diabetes (%); immunosuppression (%); renal disease (%) |
Mortality (% CR; % comparator) | Other outcomes reported |
|---|---|---|---|---|---|---|---|---|---|---|---|
|
Alicino 2015 (26464061) [22] |
Italy (none) | Tertiary teaching hospital |
489 (327) |
Critical carea population (NR) | K. pneumoniae | Median 68 (IQR 57–76) | 66.2 | NR | NR; NR; NR; NR |
30-day (36; 23.5) |
NA |
|
Brizendine 2015 (25385105) [13] |
US (NR) | Tertiary teaching hospital |
108 (22) |
Totally high-risk (transplant) | K. pneumoniae, ESBL-K. pneumoniae | Mean 53 (±12.1) | 39 | NR | 100; NR; 100; NR |
In-hospital (18; 2) |
NA |
|
Capone 2013 (23137235) [23] |
Italy (gov.) | Tertiary teaching hospitals (one long-term facility) |
97 (97) |
Partially high-risk (44.3% SOT, corticosteroid therapy, immunodeficiency) | K. pneumoniae | Median 69 (IQR 50–77) | 61.9 | Charlson comorbidity index: median 5 (IQR 3–8); APACHE II: median 15 (IQR 12–20) | NR; 35; 44.3; 28.9 (CKD) | In-hospital (27.5; NA) | NA |
|
Clancy 2013 (24011185) [24] |
US (acad., gov.) | Tertiary teaching hospital |
17 (17) |
Totally high-risk (transplant) | K. pneumoniae | Median 51 (IQR 25–70) | 59 | APACHE II: median 18 (IQR 4–26) | 100; NR; 100; 58.8 | 30-day (18; NA); 90-day (47; NA) | AE |
|
Cristina 2018 (28668656) [25] |
Italy (none) | Tertiary hospitals | 213 (213) | Partially high-risk (14% solid malignancy, 8.5% HM, 3.3% SOT) | K. pneumoniae | Median 72 (IQR 61–78) | 65.3 | Charlson comorbidity index: median 2 (IQR 1–3) | 3.29; 8.92; NR; 9.86 (chronic renal failure) | 15-day (26.3; NA) | NA |
|
Giannella 2018 (28842283) [26] |
Italy (none) | Tertiary teaching hospital |
595 (595) |
Partially high-risk (16% chemotherapy) | K. pneumoniae | Median 66 (IQR 54–76) | 62 | Charlson comorbidity index: 3; APACHE III: 20 | NR; NR; NR; 17.6 (chronic renal failure), 12.3 (hemodialysis) | 14-day (21.3; NA); in-hospital (29.6; NA) | NA |
|
Gomez-Simmonds 2015 (25878348) [27] |
US (none) | Tertiary teaching hospital |
223 (29) |
Partially high-risk (11% SOT) | K. pneumoniae | Median 62; > 65: 44% | 57 | Charlson comorbidity index ≥4: 30%; Pitt bacteremia ≥4: 31% | 15; NR; NR; 5 (ESRD requiring chronic dialysis) | 30-day (41.4; 20.6) | NA |
|
Hauck 2016 (26850824) [28] |
US (acad., gov.) | Tertiary hospital |
483 (260) |
Partially high-risk (18% any malignancy) | K. pneumoniae | BSI: median 63 (IQR 54–78); pneumonia: median 68 (IQR 58–81); UTI: median 69 (IQR 57–82); control: median 71 (IQR 63–81) | 42 | Charlson comorbidity index: median 3 (IQR 2–5) | NR; 49.9; NR; 25.9 (renal failure [creatinine > 2 mg/dL upon admission]) | In-hospital (BSI: 38; UTI: 7; pneumonia: 34; control: 9) | LOS |
|
Hoxha 2016 (26319590) [29] |
Italy (none) | NR |
98 (49) |
Critical carea (2% transplant) | K. pneumoniae | CRKP: median 72; CSKP: median 74 | 65 | Charlson comorbidity index ≥3: CRKP: 61%, CSKP: 59% | 1; NR; 36; 16 (dialysis) | 30-day (61; 20) | NA |
|
Judd 2016 (27320901) [30] |
US (NR) | Tertiary hospital |
382 (32) |
Critical carea population (NR) | P. aeruginosa | Mean 67.2 (±14.2) | 62.6 | NR | NR; NR; NR; NR | In-hospital (28.1; 8.9) | Cost, LOS |
|
Kalpoe 2012 (22467548) [31] |
US (NR) | Tertiary hospital |
175 (14) |
Totally high-risk (liver transplant) | K. pneumoniae | Median 55 (IQR 23–78) | 81 | MELD: median 21 (IQR 6–45) | 100; 31; 2 (HIV); 6 (CKD) | 1-year (71; 13.7) | NA |
|
Mazza 2017 (28457370) [32] |
Italy (NR) | NR |
310 (8) |
Totally high-risk (liver transplant) | K. pneumoniae | Median 54 (IQR 18–68) | NR | NR | 100; NR; 100; 85.5 (CRRT) | In-hospital (62.5; 30.4) | LOS, AE, mechanical ventilation |
|
Messina 2016 (26686227) [33] |
US (gov., industry) | Tertiary hospital |
287 (109) |
Partially high-risk (12% any malignancy) | K. pneumoniae | Median 70 (IQR 58–81) | 42 | Charlson comorbidity index: median 3 (IQR 2–5); Pitt bacteremia score ≥ 4: 24% | NR; 53; 12 (malignancy); 22 | NA | Readmission |
|
Micozzi 2017 (28283020) [34] |
Italy (none) | Tertiary teaching hospital |
22 (10) |
Totally high-risk (HM) | K. pneumoniae | Median 51.5 (IQR 28–68) | 35.7 | NR | NR; NR; 100; NR | Mortality (71.4; NA) | NA |
|
Nguyen 2010 (20356699) [35] |
US (NR) | Tertiary teaching hospital |
48 (48) |
Partially high-risk (42% SOT, 33% immunosuppression, 8% HIV) | K. pneumoniae | Median 60 (IQR 37–86) | 67 | mAPACHE II: median 19 (IQR 12–35) | 42 (SOT); 35; 8 (HIV); 44 (CRRT/ hemodialysis) | 30-day (42; NA) | NA |
|
Pena 2012 (22155832) [36] |
Spain (gov.) | Tertiary hospital |
632 (145) |
Partially high-risk (25% immunosuppression, 85% solid malignancy, 15% HM, 1% HIV) | P. aeruginosa | Median 68 (IQR 55.5–77.5); SAPS II: mean 42.6 (±17.9) | 69 | Charlson comorbidity index: median 2 (IQR 1–4); SAPS II: mean 42.6 (±17.9); Pitt score ≥ 2: 43% | NR; 26; 25; 16 | 30-day (35; 27) | NA |
|
Pereira 2015 (26136397) [37] |
US (none) | Tertiary teaching hospital |
304 (20) |
Totally high-risk (liver transplant) | K. pneumoniae | Median 58 (IQR 51–62) | 67 | NR | 100; 34; 100; NR | 1-year (45; 18) | NA |
|
Pouch 2015 (26341757) [38] |
US (gov.) | Tertiary teaching hospital |
100 (20) |
Totally high-risk (kidney transplant) | K. pneumoniae | CRKP: median 57 (IQR 51–67); CSKP: median 54 (IQR 40–63) | 42 | NR | 100; 27; NR; 88 (RRT), 8 (polycystic kidney disease), 100 (kidney transplant) | Mortality (30; 10) | AE |
|
Qureshi 2014 (24637691) [39] |
US (gov.) | Tertiary hospital |
133 (133) |
Partially high-risk (33% transplant, 9% solid malignancy, 42% HIV) | K. pneumoniae | ASB: median 62 (IQR 20–91); UTI: median 51 (IQR 24–67) | 37.1 | Charlson comorbidity index: ASB: median 4 (IQR 0–13); UTI: median 2 (IQR 0–7) | 33.3; 44.8; 41.9; 16.2 (moderate to severe) |
30-day (6; NA) |
LOS, readmission |
|
Salsano 2016 (27371609) [40] |
Italy (NR) | Tertiary teaching hospital |
553 (32) |
Totally high-risk (open-heart surgery) | K. pneumoniae | CRKP: median 74 (IQR 67–77); no CRKP: median 71 (IQR 63–77) | 68.5 | Charlson comorbidity index: CRKP: median 3 (IQR 1–4); no CRKP: median 1 (IQR 1–2) | NA; 23.5; 1.4 (history of immunosuppression); 16.3 (CKD) | 30-day (18.8; NA); in-hospital (25; 6) | NA |
|
Satlin 2013 (22916826) [41] |
US (found., gov.) | Tertiary teaching hospital |
18 (18) |
Totally high-risk (HM) | Mixed Enterobacteriaceae | Median 56 (IQR 24–77) | 39 | NR | 33 (stem cell); NR; 100; NR | 14-day (53; NA); in-hospital (56; NA) | Mechanical ventilation |
|
Simkins 2014 (25092500) [42] |
US (NR) | Tertiary teaching hospital |
52 (13) |
Totally high-risk (kidney transplant) | K. pneumoniae | CRKP: mean 53 (±18); CSKP: mean 55 (±16) | CRKP: 54; CSKP: 36 | NR | 100 (kidney transplant); 62 CRKP, 67 CSKP; 100; 100 | 6-month (38.5; 0); 6.5-month (46; 0) | AE |
|
Sotgiu 2018 (29621600) [43] |
Italy (none) | Tertiary teaching hospital |
46 (46) |
Partially high-risk (13% cancer) | K. pneumoniae | Mean 69.3 (±13.0) | 67.4 | NR | NR; 8.6; NR; 2.9 (chronic renal failure) | Mortality (52.3; NA) | NA |
|
Tamma 2016 (28013264) [44] |
US (acad., found., gov.) | Tertiary teaching hospital |
83 (83) |
Partially high-risk (3.9% HM, 12% SOT, 22.9% chemotherapy, 2.4% HIV) | Mixed Enterobacteriaceae | CP-CRE: median 58 (IQR 48–68); non-CP-CRE: median 58 (IQR 43–62) | CP-CRE: 59; non-CP-CRE: 63 | Pitt bacteremia ≥4: CP-CRE: 54%; non-CP-CRE: 39% | 11 CP-CRE, 13 non-CP-CRE (SOT); 5 CP-CRE, 2 non-CP-CRE (HSCT); 32 CR-CRE, 13 non-CR-CRE; NR; 8 CP-CRE, 4 non-P-CRE (ESRD) | 14-day (15.7; NA); 30-day (20.5; NA) | NA |
|
Trecarichi 2016 (27428072) [45] |
Italy (NR) | Tertiary teaching hospitals |
278 (161) |
Totally high-risk (HM) | K. pneumoniae | Age > 54: 56.1% | 54.3 | NR | 22.3 (HSCT); 12.6; 100; 4 | 21-day (52.2; 14.5) | NA |
|
Varotti 2017 (28796391) [46] |
Italy (NR) | Tertiary teaching hospital |
82 (26) |
Totally high-risk (kidney transplant) | K. pneumoniae | CRKP: mean 59 (±13); CRKP-ve: mean 53 (±14) | CRKP: 81; CRKP-ve: 84 | Clavien Dindo: CRKP: mean 2.4 (±1.5); CRKP-ve: mean 1.5 (±1.1) | 100 (kidney transplant); NR; 100; 100 (kidney transplant) | Mortality (8; NA) | AE, LOS, readmission |
Acad. Academic, AE Adverse event, APACHE Acute Physiology and Chronic Health Evaluation, ASB Asymptomatic bacteriuria, BSI Bloodstream infection, CKD Chronic kidney disease, CP-CRE Carbapenemase-producing carbapenem-resistant Enterobacteriaceae, CR Carbapenem-resistant, CRKP Carbapenem-resistant Klebsiella pneumoniae, CRRT Continuous renal replacement therapy, ESBL Extended-spectrum beta-lactamase, ESRD End stage renal disease, Found. Foundation, Gov. Government, HIV Human immunodeficiency virus, HM Hematologic malignancies, HSCT Hematopoietic stem cell transplantation, IQR Interquartile range, K. pneumoniae Klebsiella pneumonia, LOS Length of stay, MELD Model for End-Stage Liver Disease, N Number, NA Not applicable, NR Not reported, P. aeruginosa Pseudomonas aeruginosa, RRT Renal replacement therapy, SAPS Simplified Acute Physiology, SD Standard deviation, SOT Solid organ transplant, US United States, UTI Urinary tract infection
aMajority were critical care population