Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Microbial Biotechnology Research Center, Iran University of Medical Sciences, Tehran, Iran.
Ann Clin Microbiol Antimicrob. 2024 Mar 19;23(1):26. doi: 10.1186/s12941-024-00685-4.
Infections caused by Stenotrophomonas maltophilia are clinically important due to its intrinsic resistance to a broad range of antibiotics. Therefore, selecting the most appropriate antibiotic to treat S. maltophilia infection is a major challenge.
The current meta-analysis aimed to investigate the global prevalence of antibiotic resistance among S. maltophilia isolates to the develop more effective therapeutic strategies.
A systematic literature search was performed using the appropriate search syntax after searching Pubmed, Embase, Web of Science and Scopus databases (May 2023). Statistical analysis was performed using Pooled and the random effects model in R and the metafor package. A total of 11,438 articles were retrieved. After a thorough evaluation, 289 studies were finally eligible for inclusion in this systematic review and meta-analysis.
Present analysis indicated that the highest incidences of resistance were associated with doripenem (97%), cefoxitin (96%), imipenem and cefuroxime (95%), ampicillin (94%), ceftriaxone (92%), aztreonam (91%) and meropenem (90%) which resistance to Carbapenems is intrinsic. The lowest resistance rates were documented for minocycline (3%), cefiderocol (4%). The global resistance rate to TMP-SMX remained constant in two periods before and after 2010 (14.4% vs. 14.6%). A significant increase in resistance to tigecycline and ceftolozane/tazobactam was observed before and after 2010.
Minocycline and cefiderocol can be considered the preferred treatment options due to low resistance rates, although regional differences in resistance rates to other antibiotics should be considered. The low global prevalence of resistance to TMP-SMX as a first-line treatment for S. maltophilia suggests that it remains an effective treatment option.
嗜麦芽窄食单胞菌由于对多种抗生素固有耐药，导致其引起的感染具有重要的临床意义。因此，选择最合适的抗生素来治疗嗜麦芽窄食单胞菌感染是一项重大挑战。
本项荟萃分析旨在调查嗜麦芽窄食单胞菌分离株对抗生素的全球耐药率，以制定更有效的治疗策略。
通过适当的搜索语法在 Pubmed、Embase、Web of Science 和 Scopus 数据库中进行了系统文献检索（2023 年 5 月）。使用 R 和 metafor 包中的 Pooled 和随机效应模型进行了统计分析。共检索到 11438 篇文章。经过彻底评估，最终有 289 项研究符合本系统评价和荟萃分析的纳入标准。
本分析表明，耐药率最高的与多利培南（97%）、头孢西丁（96%）、亚胺培南和美罗培南（95%）、氨苄西林（94%）、头孢曲松（92%）、氨曲南（91%）和头孢他啶（90%）相关，这些抗生素对碳青霉烯类药物的耐药性是固有耐药。替加环素和头孢洛扎/他唑巴坦的耐药率最低，分别为 3%和 4%。替加环素和头孢洛扎/他唑巴坦在 2010 年前后的两个时期的全球耐药率均显著增加。2010 年前后，TMP-SMX 的耐药率也显著增加。
由于耐药率低，米诺环素和头孢地尔可被视为首选治疗方案，尽管应考虑其他抗生素的耐药率存在地区差异。TMP-SMX 作为嗜麦芽窄食单胞菌一线治疗药物的全球耐药率较低，表明其仍然是一种有效的治疗选择。
