Gu Bing, Ke Xing, Pan Shiyang, Cao Yan, Zhuang Ling, Yu Rongbin, Qian Huimin, Liu Genyan, Tong Mingqing
Department of Laboratory Medicine, the First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China; ; National Key Clinical, Department of Laboratory Medicine, Nanjing, Jiangsu 210029, China;
J Biomed Res. 2013 Mar;27(2):103-15. doi: 10.7555/JBR.27.20120125. Epub 2013 Feb 28.
Shigellosis causes diarrheal disease in humans in both developed and developing countries, and multi-drug resistance in Shigella is an emerging problem. Understanding changing resistance patterns is important in determining appropriate antibiotic treatments. This meta-analysis systematically evaluated aminoglycoside resistance in Shigella. A systematic review was constructed based on MEDLINE and EMBASE databases. Random-effect models or fixed-effect models were used based on P value considering the possibility of heterogeneity between studies for meta-analysis. Data manipulation and statistical analyses were performed using software STATA 11.0. By means of meta-analysis, we found a lower resistance to three kinds of aminoglycosides in the Europe-America areas during the 12 year study period than that of the Asia-Africa areas. Kanamycin resistance was observed to be the most common drug resistance among Shigella isolates with a prevalence of 6.88% (95%CI: 6.36%-7.43%). Comparison of data from Europe-America and Asia-Africa areas revealed that Shigella flexneri resistance was greater than the resistance calculated for Shigella sonnei. Importantly, Shigella sonnei has played a significant role in aminoglycoside-resistance in recent years. Similarly, data showed that resistance to these drugs in children was higher than the corresponding data of adults. In conclusion, aminoglycoside-resistant Shigella is not an unusual phenomenon worldwide. Distribution in Shigella resistance differs sharply based on geographic areas, periods of time and subtypes. The results from the present study highlight the need for continuous surveillance of resistance and control of antibiotic usage.
志贺氏菌病在发达国家和发展中国家都会导致人类腹泻疾病，并且志贺氏菌的多重耐药性是一个新出现的问题。了解不断变化的耐药模式对于确定合适的抗生素治疗方法很重要。这项荟萃分析系统地评估了志贺氏菌对氨基糖苷类抗生素的耐药性。基于MEDLINE和EMBASE数据库构建了一项系统评价。在进行荟萃分析时，根据考虑到研究之间存在异质性可能性的P值，使用随机效应模型或固定效应模型。使用STATA 11.0软件进行数据处理和统计分析。通过荟萃分析，我们发现在12年的研究期内，欧美地区对三种氨基糖苷类抗生素的耐药性低于亚非地区。在志贺氏菌分离株中，卡那霉素耐药性是最常见的耐药类型，流行率为6.88%（95%置信区间：6.36%-7.43%）。欧美地区和亚非地区的数据比较显示，弗氏志贺氏菌的耐药性高于宋内志贺氏菌的耐药性。重要的是，近年来宋内志贺氏菌在氨基糖苷类抗生素耐药性方面发挥了重要作用。同样，数据显示儿童对这些药物的耐药性高于成人的相应数据。总之，耐氨基糖苷类抗生素的志贺氏菌在全球并非罕见现象。志贺氏菌耐药性的分布因地理区域、时间和亚型的不同而有很大差异。本研究结果凸显了持续监测耐药性和控制抗生素使用的必要性。
