Beig Masoumeh, Ebrahimi Elaheh, Moradkasani Safoura, Goodarzi Forough, Sholeh Mohammad, Golab Narges
Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran.
Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
PLoS Negl Trop Dis. 2024 Dec 2;18(12):e0012630. doi: 10.1371/journal.pntd.0012630. eCollection 2024 Dec.
Brucellosis caused by Brucella (B. abortus) and Brucella melitensis (B. melitensis) poses a significant threat to human and animal populations. The World Health Organization (WHO) recommends rifampin and cotrimoxazole as first-line treatments for pediatric brucellosis. However, emerging resistance to these antibiotics raises concerns regarding their continued efficacy. This systematic review and meta-analysis aimed to quantitatively assess the prevalence of rifampin and cotrimoxazole resistance in B. abortus and B. melitensis.
Eligible studies were identified by systematically searching various databases, such as Scopus, PubMed, Web of Science, and EMBASE databases, using specified search terms until 18 June 2024. The inclusion criteria required studies in English to report the resistance proportion with sample size details. The meta-analysis utilized a random-effects model to assess heterogeneity using the Q-test and I2 statistic. Meta-regression and subgroup analyses explored temporal, geographical, and guideline-related variations in resistance prevalence.
Among the 905 records, 59 studies spanning 21 countries (1976 to 2024) met the inclusion criteria. The prevalence of cotrimoxazole resistance, based on 3,756 isolates, was 0.034 (95% CI, 0.017, 0.068), with increasing trends over time, especially in B. melitensis. Rifampin resistance, involving 3,938 isolates, had a prevalence of 0.046 (95% CI, 0.027, 0.077), showing temporal and species-specific increases. Subgroup analyses revealed significant variations in resistance based on temporal, geographical, and guideline-related factors.
This systematic review and meta-analysis highlighted an alarming rise in cotrimoxazole and rifampin resistance in B. abortus and B. melitensis, particularly in pediatric brucellosis. Temporal, geographical, and species-specific variations underscore the dynamic nature of antibiotic resistance, emphasizing the need for targeted interventions, surveillance, and global collaboration to preserve the efficacy of essential antibiotics in brucellosis treatment. The limitations include potential biases and the retrospective nature of the included studies, emphasizing the urgent need for standardized surveillance methodologies and robust reporting mechanisms.
由流产布鲁氏菌（B. abortus）和羊种布鲁氏菌（B. melitensis）引起的布鲁氏菌病对人类和动物群体构成重大威胁。世界卫生组织（WHO）推荐利福平和复方新诺明作为儿童布鲁氏菌病的一线治疗药物。然而，对这些抗生素的耐药性不断出现，引发了对其持续疗效的担忧。本系统评价和荟萃分析旨在定量评估流产布鲁氏菌和羊种布鲁氏菌中利福平和复方新诺明耐药性的流行情况。
通过系统检索各种数据库，如Scopus、PubMed、Web of Science和EMBASE数据库，使用特定检索词，直至2024年6月18日，确定符合条件的研究。纳入标准要求英文研究报告耐药比例及样本量细节。荟萃分析采用随机效应模型，使用Q检验和I²统计量评估异质性。Meta回归和亚组分析探讨了耐药率在时间、地理和指南相关方面的变化。
在905条记录中，来自21个国家（1976年至2024年）的59项研究符合纳入标准。基于3756株分离株，复方新诺明耐药率为0.034（95%CI，0.017，0.068），且随时间呈上升趋势，尤其是在羊种布鲁氏菌中。涉及3938株分离株的利福平耐药率为0.046（95%CI，0.027，0.077），显示出时间和物种特异性的增加。亚组分析揭示了基于时间、地理和指南相关因素的耐药性存在显著差异。
本系统评价和荟萃分析强调了流产布鲁氏菌和羊种布鲁氏菌中复方新诺明和利福平耐药性的惊人上升，尤其是在儿童布鲁氏菌病中。时间、地理和物种特异性的差异突显了抗生素耐药性的动态性质，强调需要有针对性的干预措施、监测和全球合作，以维持布鲁氏菌病治疗中基本抗生素的疗效。局限性包括潜在的偏倚以及纳入研究的回顾性性质，强调迫切需要标准化的监测方法和有力的报告机制。
