Clinical Epidemiological Analysis of the Genotypic Spectrum and Mortality Risk in Carbapenem-Resistant

Background: Carbapenem-resistant Methods: This systematic review and meta-analysis were conducted according to the PRISMA guidelines and registered in PROSPERO (CRD420251150672). PubMed, Embase, and Web of Science were systematically searched for original studies up to September 9, 2025. Eligible studies reported genotypic types of CRKP (such as KPC, OXA-48-like, NDM, IMP, and VIM) and patient mortality. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model. Subgroup analyses were performed by the genotype and region. Risk of bias was assessed using the ROBINS-I tool. Results: A total of 58 studies involving various countries and regions were included. The pooled analysis showed that CRKP infection with high-risk genotypes-defined in this study primarily as KPC and OXA-48-like types due to their strong association with increased transmission, drug resistance, and mortality-was significantly associated with increased all-cause mortality (pooled OR = 3.08, 95% CI: 2.44-3.88, Conclusions: High-risk genotypes of CRKP-defined in this study as KPC and OXA-48-like due to their strong association with increased transmission, drug resistance, and mortality-are associated with significantly increased mortality risk in infected patients, especially in China. These findings support risk stratification and personalized management of high-risk patients and provide evidence for regional prevention and control strategies. Further multicenter and mechanistic studies are warranted to improve clinical management and patient outcomes.