Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, 100 Poursina St., Keshavarz Blvd., Tehran, Iran.
Department of Microbiology, Faculty of Science, Karaj Branch, Islamic Azad University, Karaj, Iran.
J Glob Antimicrob Resist. 2019 Sep;18:12-21. doi: 10.1016/j.jgar.2019.01.020. Epub 2019 Jan 24.
Extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) have emerged as an important pathogen causing severe infections worldwide. Infections due to ESBL-KP are associated with high morbidity and mortality, especially in developing countries such as Iran. The aim of this study was to assess the pooled prevalence of ESBL-KP with different gene variants in Iran.
A literature search of Medline (via PubMed), Embase, Web of Science and Iranian Database was performed. A meta-analysis was conducted using Comprehensive Meta-Analysis Software (version 2.2, Biostat). A fixed- or random-effects model was used based on the heterogeneity test. Publication bias was determined using Begg's rank correlation and Egger's weighted regression methods.
Among 783 articles identified, 43 studies met the eligibility criteria. The pooled prevalence of ESBL-KP was 43.5% (95% CI 39.3-47.9%) among clinical K. pneumoniae isolates. Among genes encoding ESBLs during 2000-2009, SHV, CTX-M and TEM were found with prevalences of 23.3%, 15.2% and 12.3%, respectively, whilst the prevalences of SHV, CTX-M, TEM and VEB were 24%, 28.1%, 25.2% and 8.3%, respectively, during the period 2010-2018.
The prevalence of ESBL-KP has increased steadily in recent years among clinical K. pneumoniae isolates in Iran. Thus, initial identification of ESBL-KP according to Clinical and Laboratory Standards Institute (CLSI) guidelines, proper molecular approaches, and implementation of antimicrobial stewardship programmes in Iranian hospitals together with comprehensive infection control measures are urgently needed to control the dissemination of these strains.
产超广谱β-内酰胺酶肺炎克雷伯菌（ESBL-KP）的出现是全球范围内引起严重感染的重要病原体。ESBL-KP 感染与高发病率和死亡率相关，特别是在伊朗等发展中国家。本研究旨在评估伊朗不同基因变异型 ESBL-KP 的汇总流行率。
通过 Medline（通过 PubMed）、Embase、Web of Science 和伊朗数据库进行文献检索。使用 Comprehensive Meta-Analysis Software（版本 2.2，Biostat）进行荟萃分析。根据异质性检验，使用固定或随机效应模型。使用 Begg 等级相关和 Egger 加权回归方法确定发表偏倚。
在确定的 783 篇文章中，有 43 项研究符合入选标准。在临床肺炎克雷伯菌分离株中，ESBL-KP 的总流行率为 43.5%（95%CI 39.3-47.9%）。在 2000-2009 年间编码 ESBL 的基因中，SHV、CTX-M 和 TEM 的流行率分别为 23.3%、15.2%和 12.3%，而在 2010-2018 年间，SHV、CTX-M、TEM 和 VEB 的流行率分别为 24%、28.1%、25.2%和 8.3%。
近年来，伊朗临床肺炎克雷伯菌分离株中 ESBL-KP 的流行率稳步上升。因此，根据临床和实验室标准协会（CLSI）指南初步鉴定 ESBL-KP、适当的分子方法以及在伊朗医院实施抗菌药物管理计划以及综合感染控制措施，对于控制这些菌株的传播是非常必要的。
