Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Daneshgah Street, Ardabil, 5618985991, Iran.
Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
World J Pediatr. 2019 Oct;15(5):441-453. doi: 10.1007/s12519-019-00263-1. Epub 2019 Jun 1.
Shigella is one of the most common causes of childhood dysentery along with high rate of morbidity and mortality in both developing and developed countries. According to the World Health Organization (WHO) reports, the prevalence of fluoroquinolones-resistant Shigella species is increasing worldwide which can cause treatment failure of Shigella infections. Since there has not been any comprehensive information on drug-resistant Shigella species in Iran, we conducted the following meta-analysis to raise awareness.
We conducted a literature search on antibiotic resistance of Shigella species to collect published studies in Iran using national and international databases. Literature search was performed by up to Jan 30, 2019 and eligible studies were included in the meta-analysis by predefined criteria.
Antimicrobial susceptibility testing using disk diffusion technique was the only used method in all included studies. Antibiotic resistance characteristics of Shigella species against WHO recommended therapeutic regimens were as follows: S. dysenteriae 7%, S. flexneri 3.8%, S. boydii 6.9% and S. sonnei 2.6% to ciprofloxacin, S. dysenteriae 27.9%, S. flexneri 19.3%, S. boydii 15.7% and S. sonnei 9.5% to ceftriaxone and also S. dysenteriae 91.7%, S. flexneri 20.7%, S. boydii 46.7% and S. sonnei 32.3% to azithromycin. Resistance to pivmecillinam has not been investigated in Iran.
Our findings revealed that ciprofloxacin can still be used as the first-line antibiotic for Shigella infections in Iranian children. However, it seems that second-line antibiotics i.e., ceftriaxone and azithromycin are not good choices for treatment and thus not recommended.
志贺菌是导致儿童痢疾的最常见原因之一，在发展中国家和发达国家的发病率和死亡率都很高。根据世界卫生组织（WHO）的报告，氟喹诺酮类耐药志贺菌在全球范围内的流行率正在上升，这可能导致志贺菌感染的治疗失败。由于伊朗没有关于耐药志贺菌的综合信息，我们进行了以下荟萃分析以提高认识。
我们对志贺菌的抗生素耐药性进行了文献检索，以收集伊朗发表的研究报告，使用了国家和国际数据库。文献检索截至 2019 年 1 月 30 日，并根据预设标准将符合条件的研究纳入荟萃分析。
所有纳入的研究均仅使用纸片扩散法进行抗菌药物敏感性试验。志贺菌对世界卫生组织推荐的治疗方案的抗生素耐药特征如下：S. dysenteriae 为 7%，S. flexneri 为 3.8%，S. boydii 为 6.9%和 S. sonnei 为 2.6%对环丙沙星耐药，S. dysenteriae 为 27.9%，S. flexneri 为 19.3%，S. boydii 为 15.7%和 S. sonnei 为 9.5%对头孢曲松耐药，S. dysenteriae 为 91.7%，S. flexneri 为 20.7%，S. boydii 为 46.7%和 S. sonnei 为 32.3%对阿奇霉素耐药。伊朗尚未对匹美西林耐药性进行调查。
我们的研究结果表明，环丙沙星仍可作为伊朗儿童志贺菌感染的一线抗生素。然而，似乎头孢曲松和阿奇霉素等二线抗生素不是治疗的好选择，因此不推荐使用。
