临床分离株中形成生物膜的粪肠球菌的全球患病率：一项系统评价和荟萃分析。

The global prevalence of biofilm-forming Enterococcus faecalis in clinical isolates: a systematic review and meta-analysis.

作者信息

Tamrat Ephrem, Asmare Zelalem, Geteneh Alene, Sisay Assefa, Getachew Ermias, Kassanew Brhanu, Dessale Mesfin, Gashaw Yalewayker, Jemal Abdu, Gashaw Muluken, Bazezew Alembante, Gedfie Solomon, Kassahun Woldeteklehaymanot, Abebe Wagaw, Dejazmach Zelalem, Misganaw Tadesse, Ashagre Agenagnew, Nigatie Marye, Damtie Abebe Adisu, Alemu Bewuketu Belete, Tefera Zewdu, Mezgebu Bahriew, Kumie Getinet, Kiros Mulugeta, Reta Melese Abate

机构信息

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia.

出版信息

BMC Infect Dis. 2025 Aug 5;25(1):981. doi: 10.1186/s12879-025-11399-z.

DOI:10.1186/s12879-025-11399-z

PMID:40764534

Abstract

BACKGROUND

Enterococcus faecalis (E. faecalis) is a major cause of healthcare-associated infections (HAIs). It exhibits a strong biofilm-forming ability, which contributes to treatment resistance and persistence. Despite its clinical relevance, the global prevalence of biofilm-forming E. faecalis remains poorly defined. This study aimed to estimate the pooled prevalence of biofilm-forming E. faecalis in clinical isolates worldwide.

METHODS

Following PRISMA 2020 guidelines, we systematically searched PubMed, Scopus, ScienceDirect, Google Scholar, and institutional repositories for studies published between 2015 and 2024. A total of 56 studies involving 3,739 clinical isolates met the inclusion criteria. We used a random-effects model to estimate pooled prevalence and conducted subgroup analyses based on WHO region, continent, publication year, specimen type, and biofilm detection method. Meta-regression and sensitivity analyses assessed heterogeneity and robustness. Publication bias was evaluated using Egger's test and corrected with trim-and-fill analysis.

RESULTS

The global pooled prevalence of biofilm-forming E. faecalis was 68.68% (95% CI: 61.33-76.02%), with significant heterogeneity (I² = 99.30%). By WHO region, prevalence ranged from 57.93% (95% CI: 41.01-71.85%) in South-East Asia to 73.66% (95% CI: 63.40-83.92%) in the Eastern Mediterranean. By continent, South America (all from Brazil) showed the highest prevalence at 89.79% (95% CI: 73.02-106.56%). Studies from 2021 to 2024 reported higher prevalence (76.18%, 95% CI: 66.25-86.11%) than those from 2015 to 2020. Among specimens, urine showed the highest prevalence (80.47%, 95% CI: 61.17-99.77%). Among biofilm-positive isolates, 47.92% (95% CI: 39.34-56.51%) were strong producers. Meta-regression identified WHO region (p = 0.005) and specimen type (p = 0.043) as significant sources of heterogeneity. Egger's test indicated publication bias (p = 0.0066), but trim-and-fill analysis yielded a consistent adjusted prevalence of 68.08%.

CONCLUSION

Biofilm formation is highly prevalent in E. faecalis clinical isolates globally, with substantial regional and specimen-based variation. These findings highlight the urgent need for standardized biofilm detection protocols, improved infection prevention and control, tailored antibiotic stewardship, and the development of anti-biofilm therapies to mitigate biofilm-associated resistance and enhance patient outcomes.

摘要

背景

粪肠球菌是医疗保健相关感染（HAIs）的主要病因。它具有很强的生物膜形成能力，这导致了治疗耐药性和持续性。尽管其具有临床相关性，但全球形成生物膜的粪肠球菌的流行情况仍不清楚。本研究旨在估计全球临床分离株中形成生物膜的粪肠球菌的合并流行率。

方法

按照PRISMA 2020指南，我们系统检索了PubMed、Scopus、ScienceDirect、谷歌学术和机构知识库中2015年至2024年发表的研究。共有56项涉及3739株临床分离株的研究符合纳入标准。我们使用随机效应模型估计合并流行率，并根据世界卫生组织（WHO）区域、大洲、出版年份、标本类型和生物膜检测方法进行亚组分析。Meta回归和敏感性分析评估了异质性和稳健性。使用Egger检验评估发表偏倚，并用剪补法进行校正。

结果

全球形成生物膜的粪肠球菌的合并流行率为68.68%（95%置信区间：61.33 - 76.02%），具有显著异质性（I² = 99.30%）。按WHO区域划分，东南亚的流行率为57.93%（95%置信区间：41.01 - 71.85%），东地中海为73.66%（95%置信区间：63.40 - 83.92%）。按大洲划分，南美洲（均来自巴西）的流行率最高，为89.79%（95%置信区间：73.02 - 106.56%）。2021年至2024年的研究报告的流行率（76.18%，95%置信区间：66.25 - 86.11%）高于2015年至2020年的研究。在标本中，尿液中的流行率最高（80.47%，95%置信区间：61.17 - 99.77%）。在生物膜阳性分离株中，47.92%（95%置信区间：39.34 - 56.51%）为强生产者。Meta回归确定WHO区域（p = 0.005）和标本类型（p = 0.043）是异质性的重要来源。Egger检验表明存在发表偏倚（p = 0.0066），但剪补法得出的一致调整后流行率为68.08%。