Alimoghadam Shaya, Eslami Arvin, Alimoghadam Rojina, Bahrami Mianrood Ibrahim, Azizmohammad Looha Mehdi, Khodadadi Sanaz, Shokouhi Shervin, Alavi Darazam Ilad
Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Infectious Diseases, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Glob Antimicrob Resist. 2024 Dec;39:159-169. doi: 10.1016/j.jgar.2024.08.014. Epub 2024 Sep 18.
Pseudomonas aeruginosa is a major opportunistic pathogen responsible for a wide range of infections. The emergence of antibiotic resistance in this pathogen poses a significant public health challenge. This study aims to conduct a comprehensive meta-analysis of studies conducted in Iran to determine the frequency of key antibiotic resistance mechanisms in Pseudomonas aeruginosa and their association with multidrug-resistant and extensively drug-resistant strains or pandrug-resistant strains.
Systematic database searches encompassing literature up to June 2023 were undertaken. The selected studies centered on OprD downregulation, efflux pump (mexAB-OprM, mexXY-OprM) expression, and AmpC overproduction. Extracted data were synthesised in a meta-analysis for pooled frequency determination of each resistance mechanism.
In total, 24 studies were included. OprD downregulation exhibited a pooled frequency of 61%. Efflux pump component frequency ranged from 48% to 77.5%. AmpC overproduction was identified in 29.1% of isolates. Polymyxin B and colistin demonstrated lower antibiotic resistance rates, with pooled frequency of 1% and 1.6%, respectively. Conversely, resistance to other antibiotics ranged widely, with pooled frequency spanning 38.4% to 98.2%.
This study underscores the concerning frequency of diverse antibiotic resistance mechanisms in Pseudomonas aeruginosa strains from Iran. Concurrent OprD downregulation, mexAB, mexXY, OprM expression, and AmpC overproduction highlight the urgent need for stringent infection control and prudent antibiotic usage to curb the dissemination of these resistant strains.
CRD42022379311.
铜绿假单胞菌是一种主要的机会致病菌，可引发多种感染。该病原菌中抗生素耐药性的出现对公共卫生构成了重大挑战。本研究旨在对伊朗开展的研究进行全面的荟萃分析，以确定铜绿假单胞菌中关键抗生素耐药机制的频率及其与多重耐药、广泛耐药菌株或全耐药菌株的关联。
进行了系统的数据库检索，涵盖截至2023年6月的文献。所选研究集中于外膜孔蛋白D（OprD）下调、外排泵（mexAB - OprM、mexXY - OprM）表达以及AmpC过度产生。提取的数据在荟萃分析中进行综合，以确定每种耐药机制的合并频率。
总共纳入了24项研究。OprD下调的合并频率为61%。外排泵成分频率在48%至77.5%之间。29.1%的分离株中发现有AmpC过度产生。多粘菌素B和黏菌素的抗生素耐药率较低，合并频率分别为1%和1.6%。相反，对其他抗生素的耐药率范围广泛，合并频率在38.4%至98.2%之间。
本研究强调了伊朗铜绿假单胞菌菌株中多种抗生素耐药机制的令人担忧的频率。同时出现的OprD下调、mexAB、mexXY、OprM表达以及AmpC过度产生凸显了严格的感染控制和谨慎使用抗生素以遏制这些耐药菌株传播的迫切需求。
国际前瞻性系统评价注册库（PROSPERO）：CRD42022379311。
