Salleh Mohd Zulkifli, Nik Zuraina Nik Mohd Noor, Hajissa Khalid, Ilias Mohamad Ikram, Deris Zakuan Zainy
Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian 16150, Malaysia.
Department of Zoology, Faculty of Science and Technology, Omdurman Islamic University, P.O. Box 382, Omdurman 14415, Sudan.
Antibiotics (Basel). 2022 Sep 29;11(10):1333. doi: 10.3390/antibiotics11101333.
Diarrhea is one of the leading causes of morbidity and mortality in developing countries. Diarrheagenic (DEC) is an important bacterial agent for diarrhea in infants, children, and international travelers, and accounts for more than 30% of diarrheal cases in children less than 5 years old. However, the choices of antimicrobial agents are now being limited by the ineffectiveness of many first-line drugs, in relation to the emergence of antimicrobial-resistant strains. The aim of this systematic review and meta-analysis was to provide an updated prevalence of antimicrobial-resistant DEC in Asia. A comprehensive systematic search was conducted on three electronic databases (PubMed, ScienceDirect, and Scopus), where 40 eligible studies published between 2010 and 2022 were identified. Using meta-analysis of proportions and a random-effects model, the pooled prevalence of DEC in Asian diarrheal patients was 22.8% (95% CI: 16.5-29.2). The overall prevalence of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)-producing DEC strains was estimated to be 66.3% (95% CI: 58.9-73.7) and 48.6% (95% CI: 35.1-62.1), respectively. Considering antimicrobial drugs for DEC, the resistance prevalence was highest for the penicillin class of antibiotics, where 80.9% of the DEC isolates were resistant to amoxicillin and 73.5% were resistant to ampicillin. In contrast, resistance to carbapenems such as imipenem (0.1%), ertapenem (2.6%), and meropenem (7.9%) was the lowest. The relatively high prevalence estimation signifies that the multidrug-resistant DEC is a public health threat. Effective antibiotic treatment strategies, which may lead to better outcomes for the control of infections in Asia, are necessary.
腹泻是发展中国家发病和死亡的主要原因之一。致泻性大肠埃希菌（DEC）是婴儿、儿童及国际旅行者腹泻的重要细菌病原体，在5岁以下儿童腹泻病例中占比超过30%。然而，由于许多一线药物无效以及抗菌药物耐药菌株的出现，抗菌药物的选择受到了限制。本系统评价和荟萃分析的目的是提供亚洲地区抗菌药物耐药性DEC的最新流行率。我们在三个电子数据库（PubMed、ScienceDirect和Scopus）上进行了全面的系统检索，共确定了2010年至2022年间发表的40项符合条件的研究。采用比例荟萃分析和随机效应模型，亚洲腹泻患者中DEC的合并流行率为22.8%（95%置信区间：16.5 - 29.2）。产多重耐药（MDR）和超广谱β-内酰胺酶（ESBL）的DEC菌株的总体流行率估计分别为66.3%（95%置信区间：58.9 - 73.7）和48.6%（95%置信区间：35.1 - 62.1）。考虑到用于DEC的抗菌药物，青霉素类抗生素的耐药流行率最高，80.9%的DEC分离株对阿莫西林耐药，73.5%对氨苄西林耐药。相比之下，对亚胺培南（0.1%）、厄他培南（2.6%）和美罗培南（7.9%）等碳青霉烯类药物的耐药率最低。相对较高的流行率估计表明多重耐药DEC是一种公共卫生威胁。有必要制定有效的抗生素治疗策略，这可能会为亚洲控制感染带来更好的结果。
