Department of Microbiology, Pasteur Institute of Iran, Tehran, Iran.
Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran.
PeerJ. 2023 Mar 30;11:e15121. doi: 10.7717/peerj.15121. eCollection 2023.
Knowledge of global clarithromycin (CLA)-resistant rates of () is crucial for decision of the most appropriate eradication therapies with good clinical outcomes. Therefore, this review and meta-analysis aimed to evaluate the global prevalence of the CLA resistance in to provide some guidance for selecting the first-line antibiotics.
A comprehensive search was performed for relevant literature until April 2021 in PubMed, Embase, and Web of Science databases. Freeman-Tukey double arcsine transformation was performed to estimate the weighted pooled prevalence of resistance.
The meta-analysis included 248 articles. The prevalence of CLA-resistant was 27.53% (95% CI [25.41-29.69]). The heterogeneity between reports was significant (I = 97.80%, < 0.01). The resistance rate increased from 24.28% in 2010-2017 to 32.14% in 2018-2021 ( < 0.01). Iran, with 38 articles, has the most report. Nevertheless, Switzerland, Portugal, and Israel had the highest resistance rates (67.16%, 48.11%, and 46.12%, respectively). The heterogeneity between the continents and the antimicrobial susceptibility methods also interpreted standard guidelines and breakpoints was insignificant ( > 0.05).
Overall CLA resistance rate was 27.53%, worldwide. The difference in CLA resistance rate among the included studies can be due to several reasons such as differences in antibiotic prescription rates in various geographic areas, use of different breakpoints or inaccurate criteria in performed studies, and the emergence of multidrug-resistant (MDR) strains.
了解全球克拉霉素（CLA）耐药率对于选择具有良好临床疗效的最佳根除疗法至关重要。因此，本综述和荟萃分析旨在评估全球对 的 CLA 耐药率，为选择一线抗生素提供一些指导。
在 PubMed、Embase 和 Web of Science 数据库中全面检索了相关文献，检索时间截至 2021 年 4 月。采用 Freeman-Tukey 双反正弦变换估计耐药的加权汇总患病率。
荟萃分析纳入了 248 篇文章。CLA 耐药 的患病率为 27.53%（95%CI[25.41-29.69]）。报告之间的异质性显著（I=97.80%， < 0.01）。耐药率从 2010-2017 年的 24.28%增加到 2018-2021 年的 32.14%（ < 0.01）。伊朗有 38 篇报道，位居榜首。然而，瑞士、葡萄牙和以色列的耐药率最高（分别为 67.16%、48.11%和 46.12%）。各大陆和抗菌药物敏感性试验方法之间的异质性以及解释标准指南和折点的异质性均无统计学意义（ > 0.05）。
总体而言，全球 CLA 耐药率为 27.53%。纳入研究中 CLA 耐药率的差异可能归因于多种原因，例如不同地理区域抗生素处方率的差异、在不同研究中使用不同的折点或不准确的标准，以及多药耐药（MDR）菌株的出现。
