临床分离革兰氏阴性杆状菌的粘菌素耐药负担:系统综述和荟萃分析

Razieh Amirfakhrian, Atieh Yaghobi, R. Ghaderi, S. Hashemy, K. Ghazvini
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引用次数: 0

摘要

近几十年来,抗生素的不当使用和可转移耐药因素的存在导致了多重耐药(MDR)革兰氏阴性菌的出现。抗菌素耐药性正在成为公共卫生面临的主要挑战之一,并已在世界范围内造成发病率和死亡率。本研究的目的是评估伊朗和世界各地革兰氏阴性杆菌(肠杆菌科、不动杆菌科和假单胞菌科)中粘菌素耐药性的患病率和频率。方法:在这项系统评价和荟萃分析中,我们检索了1998年至2018年的国际和国家数据库,包括PubMed、谷歌Scholar、SID和Magiran,以获取描述革兰氏阴性杆菌粘菌素耐药性的文章和摘要。我们纳入了92项符合纳入标准的研究,并使用随机效应模型将结果结合起来,得出革兰氏阴性杆菌中粘菌素耐药的发生率。采用综合meta分析软件(Comprehensive Meta-Analysis Software, V2)对数据进行分析,采用I2指数评价研究的异质性。结果:在11050篇论文中,92篇研究符合严格的纳入标准,最终被纳入。革兰氏阴性杆菌(GNB)对粘菌素的总体耐药率为6.6%,不动杆菌(n = 18504)对粘菌素的耐药率为2.8%(摘要:95%可信区间(CI): [0.02, 0.041], P = 0.001, I2 = 70, df (Q) = 36, Q值= 121.924)。假单胞菌(n = 15094)对粘菌素的耐药率为3% (95% CI: [0.022, 0.041], P = 0.001, I2 = 68.3, df (Q) = 25, Q值= 85.648),肠杆菌科(n = 44772)对粘菌素的耐药率为0.8% (95% CI: [0.004, 0.014], P = 0.001, I2 = 87.6, df (Q) = 15, Q值= 71.291)。因此,GNB对粘菌素的耐药率相对较低(6.6%)。结论:GNB对粘菌素耐药率较低。因此,这种抗菌剂仍然可以作为对碳青霉烯类等其他抗生素耐药的GNB的合适选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Colistin Resistance Burden among Clinical Isolates of Gram-negative Rods: A Systematic Review and Meta-analysis
Introduction: In recent decades, the inappropriate use of antibiotics and the existence of transferable resistant elements have caused the emergence of multidrug-resistant (MDR) gram-negative organisms. Antimicrobial resistance is becoming one of the major challenges to public health and has caused morbidity and mortality worldwide. The purpose of this study was the assessment of the prevalence and frequency of colistin resistance among gram-negative bacilli (Enterobacteriaceae, Acinetobacter spp., and Pseudomonas spp.) in Iran and around the world. Methods: For this systematic review and meta-analysis, we searched international and national databases, including PubMed, Google Scholar, SID, and Magiran, from 1998 to 2018 for articles and abstracts describing colistin resistance among gram-negative bacilli. We have included 92 studies that met our inclusion criteria, and the outcomes were combined using a random-effects model to derive the event rate of colistin resistance among gram-negative bacilli. Data were analyzed by the Comprehensive Meta-Analysis Software (V2), and the heterogeneity of the studies was assessed using the I2 index. Results: Out of the 11050 papers identified, 92 studies met the strict inclusion criteria and were finally included. The overall event rate of colistin resistance among gram-negative bacilli (GNB) was about 6.6%, while the event rate of colistin resistance among Acinetobacter spp. (n = 18504) was 2.8% (summary: 95% confidence interval (CI): [0.02, 0.041], P = 0.001, I2 = 70, df (Q) = 36, Q-value = 121.924). The colistin resistance among Pseudomonas spp. (n = 15094) was 3% (95% CI: [0.022, 0.041], P = 0.001, I2 = 68.3, df (Q) = 25, Q-value = 85.648), and the colistin resistance among Enterobacteriaceae spp. (n = 44772) was 0.8% (95% CI: [0.004, 0.014], P = 0.001, I2 = 87.6, df (Q) = 15, Q-value = 71.291). Therefore, the event rate of resistance to colistin among GNB was relatively low (6.6%). Conclusion: The event rate of resistance to colistin among GNB was low. Therefore, this antimicrobial agent can still be administered as a suitable option against GNB that are resistant to other antibiotics such as carbapenems.
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