Beigverdi Reza, Sattari-Maraji Azin, Jabalameli Fereshteh, Emaneini Mohammad
Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Microb Drug Resist. 2020 Feb;26(2):126-135. doi: 10.1089/mdr.2019.0139. Epub 2019 Aug 29.
Several studies have investigated the genes encoding aminoglycoside-modifying enzymes (AMEs) among gram-positive cocci (GPC) such as , methicillin-resistant (MRSA), coagulase-negative staphylococci (CoNS), and spp. in Iran; however, a comprehensive analysis has not yet been performed. Thus, the present systematic review and meta-analysis was conducted to determine the prevalence of genes encoding AMEs among GPC in Iran. A systematic review of the data published in the English and Persian languages from January 2000 to October 2018 was performed by searching different electronic databases (Medline, Embase, Web of Science, and the Iranian Database). Meta-analysis was performed by using the Comprehensive Meta-Analysis (Biostat V2.2) software. Cochran's Q and statistics were used to test heterogeneity, and publication bias was assessed by using funnel plot and Begg's and Egger's tests. Out of 117 studies, 28 were considered eligible for inclusion in the current meta-analysis. The most prevalent AMEs gene among GPC was , with a prevalence of 97.7% (95% CI; 94.4-99) in high-level gentamicin-resistant enterococci and 67.7% (95% CI; 59.2-75.2) in MRSA. The second most common gene was , with a prevalence of 45.3% (95% CI; 23.9-68.6) in MRSA. It was ultimately determined that the prevalence of AMEs genes among GPC had reached alarming levels in Iran; therefore, aminoglycosides should be prescribed with caution by clinicians. The implementation of a regional and nationwide surveillance system to monitor antimicrobial resistance, especially aminoglycosides, and increasing the awareness of AMEs genes among clinicians are essential to guiding empirical and pathogen-specific therapy.
多项研究对伊朗革兰氏阳性球菌（GPC）如耐甲氧西林金黄色葡萄球菌（MRSA）、凝固酶阴性葡萄球菌（CoNS）和肠球菌属中编码氨基糖苷类修饰酶（AMEs）的基因进行了调查；然而，尚未进行全面分析。因此，开展了本系统评价和荟萃分析，以确定伊朗GPC中编码AMEs基因的流行情况。通过检索不同的电子数据库（Medline、Embase、Web of Science和伊朗数据库），对2000年1月至2018年10月以英文和波斯文发表的数据进行了系统评价。使用综合荟萃分析（Biostat V2.2）软件进行荟萃分析。采用Cochran's Q和I²统计量检验异质性，并通过漏斗图以及Begg检验和Egger检验评估发表偏倚。在117项研究中，28项被认为符合纳入当前荟萃分析的条件。GPC中最常见的AMEs基因是aac(6')-Ii，在高水平庆大霉素耐药肠球菌中的流行率为97.7%（95%CI：94.4 - 99），在MRSA中的流行率为67.7%（95%CI：59.2 - 75.2）。第二常见的基因是ant(6)-Ia，在MRSA中的流行率为45.3%（95%CI：23.9 - 68.6）。最终确定，伊朗GPC中AMEs基因的流行率已达到令人担忧的水平；因此，临床医生应谨慎使用氨基糖苷类药物。实施区域和全国性监测系统以监测抗菌药物耐药性，尤其是氨基糖苷类耐药性，并提高临床医生对AMEs基因的认识，对于指导经验性治疗和针对病原体的治疗至关重要。
