Global Trends in Carbapenem-Resistant Gram-Negative Bacteria Research (2020–2025): A Bibliometric Analysis and Systematic Review

Xiaotong Zhang¹Ce Zhang¹Mengyao Lv¹Shu Wang¹Qiuting Wang¹Chengshuai Yang¹Qian Zhao¹Luyuan Ma¹Bei Li²Xiaohua Qin^3*Caiyan Zhao^1*Chuan Shen^1*

• ¹Third Hospital of Hebei Medical University, Shijiazhuang, China
• ²Qinghe People's Hospital, Xingtai, China
• ³Huashan Hospital Fudan University, Shanghai, China

Background: Carbapenem-resistant Gram-negative bacteria (CRGNB) pose a severe global health threat, yet comprehensive bibliometric analyses in this field remain limited. This systematic review employs a bibliometric methodology to identify research hotspots and emerging trends from 2020 to 2025. Method: Literature published between January 1, 2020, and October 31, 2025, was retrieved from the Web of Science Core Collection (WoSCC), Scopus, and PubMed for bibliometric analysis.. Analytical tools, including VOSviewer, CiteSpace, and the Bibliometrix package, were used to assess publications by number, country, institution, journal, author, and keywords. Results: The bibliometric analysis revealed that global CRGNB research has experienced a fluctuating growth trend. China was the leading contributor, with 2,950 publications (25.5% of the total), and demonstrated significant collaboration with the USA and the UK. Major research clusters encompassed hypervirulent CRGNB strains (particularly carbapenem-resistant Klebsiella pneumoniae and Escherichia coli), resistance mechanisms (particularly carbapenemase-producing), antibiotic resistance, emerging therapeutic strategies (such as novel β-lactam/β-lactamase inhibitors, siderophore antibiotics, phage therapy, and antimicrobial peptides) and One Health perspectives (addressing environmental reservoirs). Thematic analysis identified evolving research priorities, including hypervirulent CRGNB strains, artificial intelligence, and early diagnosis and rapid screening of carbapenem resistance, exemplified by clustered regularly interspaced short palindromic repeats-based detection and artificial intelligence-driven matrix assisted laser desorption ionization-time of flight analysis.. Randomized controlled trials indicated promising outcomes for several new antimicrobial agents, such as cefiderocol, sulbactam-durlobactam, and imipenem-relebactam. However, safety concerns, particularly in critically ill patients, remain a significant challenge. Conclusion: CRGNB research is increasingly directed toward elucidating resistance mechanisms, improving diagnostic tools, and exploring non-antibiotic therapeutic options. Strengthening international collaboration and fostering multidisciplinary approaches are imperative to advance high-quality research and address this growing threat.