Relationship between antibiotic exposure and carbapenem-resistant Klebsiella pneumoniae infection within four types of control patients: A systematic review and meta-analysis.

OBJECTIVES: This study attempted to identify the relationship between antibiotic exposure and risk of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection. METHODS: Antibiotic exposure was analysed as a risk factor for CRKP infection, cases of which were extracted from research articles indexed in PubMed, EMBASE, and the Cochrane Library. Relevant studies published until January 2023 were reviewed, and a meta-analysis was conducted on antibiotic exposure within four types of control groups, which comprised 52 studies. RESULTS: The four types of control groups included carbapenem-susceptible K. pneumoniae infections (CSKP; comparison 1); other infections, especially without CRKP infection (comparison 2); CRKP colonisation (comparison 3); and no infection (comparison 4). Carbapenems exposure and Aminoglycosides exposure were two risk factors common to the four comparison groups. Compared with the risk of CSKP infection, tigecycline exposure in bloodstream infections and quinolone exposure within 30 days were associated with an increased risk of CRKP infection. However, the risk of CRKP infection associated with tigecycline exposure in mixed (MIX) infections (infections involving two or more different infection sites) and quinolone exposure within 90 days was similar to the risk of CSKP infection. CONCLUSION: Carbapenems and Aminoglycosides exposure are likely risk factors for CRKP infection. Antibiotic exposure time as a continuous variable was not associated with the risk of CRKP infection, compared with the risk of CSKP infection. Tigecycline exposure in MIX infections and quinolone exposure within 90 days may not increase the risk of CRKP infection.

Efficacy and Safety of Shortened Dual Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials.

ABSTRACT: To update the efficacy and safety of short-term (≤3 months) dual antiplatelet therapy (DAPT) and standard (6-12 months) DAPT in patients undergoing percutaneous coronary intervention. In addition, we also explored the duration of DAPT in patients at high bleeding risk (HBR). In PubMed, Embase, and Cochrane Library, we electronically searched among all the studies from the establishment of the database to December 8, 2021, for randomized controlled trials (RCTs). Nine randomized controlled trials (45,661 patients) ultimately met the inclusion criteria. The pooled analysis revealed that, compared with standard DAPT, ≤3-month DAPT significantly reduced major adverse cardiovascular event {hazard ratio (HR) = 0.89, 95% confidence interval (CI) [0.82-0.97]}, all-cause mortality [HR = 0.88, 95% CI (0.78-0.99)], cardiovascular mortality [HR = 0.79, 95% CI (0.65-0.97)], major bleeding [HR = 0.72, 95% CI (0.56-0.93)], and any bleeding [HR = 0.57, 95% CI (0.50-0.66)], while no significant differences in the risk of myocardial infarction, stent thrombosis, and stroke. In patients with HBR, the results showed that ≤3-month DAPT significantly reduced major bleeding [HR = 0.35, 95% CI (0.14-0.88)] and any bleeding [HR = 0.53, 95% CI (0.41-0.67)] compared with standard DAPT, while the risk of other outcomes was not statistically different. In conclusion, this study showed that ≤3-month DAPT may be a valid option for most patients after percutaneous coronary intervention. Because reductions in major adverse cardiovascular event, all-cause mortality, and cardiovascular mortality were not seen in patients with HBR, this also highlights the need for specific studies in these patients about optimal duration of antiplatelet therapy.