Systematic Review and Meta-analysis of Carbapenem Resistance of Acinetobacter baumannii in Iran

Introduction: The prevalence of carbapenem resistance in Acinetobacter baumannii has been increasing worldwide, and therapeutic options are extremely limited. We performed a systematic review to evaluate the phenotypic and genotypic carbapenem resistance in A.baumannii reported in Iran. Methods: We systematically searched Pub Med, Web of Science Direct, and Google scholar databases to identify studies addressing the carbapenem resistance of A. baumannii. The selected papers were published between 2005 and 2016, but the sample collection period was between 2002 and 2016. To estimate the prevalence, the Der Simonian and Laird randomized models, a 95% confidence interval, was used. For the heterogeneity check, I2 test was used. The Egger test was used to check the propagation bias. Results: Analysis of data indicates that there was an increase in resistance to carbapenems from 4.5% in 2005 to a 100% prevalence rate in 2016 (65.4 (95% CI: 58.8 – 71.6). Conclusion: According to the results of this study, the rate of resistance to carbapenem in A.baumannii has been increasing in Iran. The presence of carbapenem-resistant isolates is a major concern, because carbapenem is the main drug used against Multi Drug Resistant (MDR) isolates.

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Antimicrobial Resistance of Acinetobacter baumannii to Imipenem in Iran: A Systematic Review and Meta-Analysis

The Open Microbiology Journal ◽

10.2174/1874285801610010032 ◽

2016 ◽

Vol 10 (1) ◽

pp. 32-42 ◽

Cited By ~ 18

Author(s):

Maryam Pourhajibagher ◽

Farhad B. Hashemi ◽

Babak Pourakbari ◽

Masoud Aziemzadeh ◽

Abbas Bahador

Keyword(s):

Systematic Review ◽

Acinetobacter Baumannii ◽

Web Of Science ◽

Meta Analysis ◽

Control Policy ◽

Cochrane Library ◽

Drug Resistant ◽

Nosocomial Pathogen ◽

Exclusion Criteria ◽

Secondary Screening

Imipenem-resistant multi-drug resistant (IR-MDR) Acinetobacter baumannii has been emerged as a morbidity successful nosocomial pathogen throughout the world. To address imipenem being yet the most effective antimicrobial agent against A. baumannii to control outbreaks and treat patients, a systematic review and meta-analysis was performed to evaluate the prevalence of IR-MDR A. baumannii. We systematically searched Web of Science, PubMed, MEDLINE, Science Direct, EMBASE, Scopus, Cochrane Library, Google Scholar, and Iranian databases to identify studies addressing the antibiotic resistance of A. baumannii to imipenem and the frequency of MDR strains in Iran. Out of 58 articles and after a secondary screening using inclusion and exclusion criteria and on the basis of title and abstract evaluation, 51 studies were selected for analysis. The meta-analysis revealed that 55% [95% confidence interval (CI), 53.0–56.5] of A. baumannii were resistant to imipenem and 74% (95% CI, 61.3–83.9) were MDR. The MDR A. baumannii population in Iran is rapidly changing toward a growing resistance to imipenem. Our findings highlight the critical need for a comprehensive monitoring and infection control policy as well as a national susceptibility review program that evaluates IR-MDR A. baumannii isolates from various parts of Iran.

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Carbapenem Resistance, Initial Antibiotic Therapy, and Mortality inKlebsiella pneumoniaeBacteremia: A Systematic Review and Meta-Analysis

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.197 ◽

2017 ◽

Vol 38 (11) ◽

pp. 1319-1328 ◽

Cited By ~ 25

Author(s):

Philipp P. Kohler ◽

Cheryl Volling ◽

Karen Green ◽

Elizabeth M. Uleryk ◽

Prakesh S. Shah ◽

...

Keyword(s):

Systematic Review ◽

Antibiotic Therapy ◽

Meta Analysis ◽

Carbapenem Resistance ◽

Carbapenem Resistant ◽

Initial Antibiotic Therapy ◽

Meta Regression ◽

The Difference ◽

Meta Regression Analysis ◽

The Impact

BACKGROUNDMortality associated with infections caused by carbapenem-resistantEnterobacteriaceae(CRE) is higher than mortality due to carbapenem-sensitive pathogens.OBJECTIVETo examine the association between mortality from bacteremia caused by carbapenem-resistant (CRKP) and carbapenem-sensitiveKlebsiella pneumoniae(CSKP) and to assess the impact of appropriate initial antibiotic therapy (IAT) on mortality.DESIGNSystematic review and meta-analysisMETHODSWe searched MEDLINE, EMBASE, CINAHL, and Wiley Cochrane databases through August 31, 2016, for observational studies reporting mortality among adult patients with CRKP and CSKP bacteremia. Search terms were related toKlebsiella, carbapenem-resistance, and infection. Studies including fewer than 10 patients per group were excluded. A random-effects model and meta-regression were used to assess the relationship between carbapenem-resistance, appropriateness of IAT, and mortality.RESULTSMortality was higher in patients who had CRKP bacteremia than in patients with CSKP bacteremia (15 studies; 1,019 CRKP and 1,148 CSKP patients; unadjusted odds ratio [OR], 2.2; 95% confidence interval [CI], 1.8–2.6; I2=0). Mortality was lower in patients with appropriate IAT than in those without appropriate IAT (7 studies; 658 patients; unadjusted OR, 0.5; 95% CI, 0.3–0.8; I2=36%). CRKP patients (11 studies; 1,326 patients; 8-year period) were consistently less likely to receive appropriate IAT (unadjusted OR, 0.5; 95% CI, 0.3–0.7; I2=43%). Our meta-regression analysis identified a significant association between the difference in appropriate IAT and mortality (OR per 10% difference in IAT, 1.3; 95% CI, 1.0–1.6).CONCLUSIONSAppropriateness of IAT is an important contributor to the observed difference in mortality between patients with CRKP bacteremia and patients with CSKP bacteremia.Infect Control Hosp Epidemiol2017;38:1319–1328

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Predictors of mortality in patients infected with carbapenem-resistant Acinetobacter baumannii: A systematic review and meta-analysis

American Journal of Infection Control ◽

10.1016/j.ajic.2019.03.003 ◽

2019 ◽

Vol 47 (9) ◽

pp. 1140-1145 ◽

Cited By ~ 15

Author(s):

Xingran Du ◽

Xinfeng Xu ◽

Jing Yao ◽

Kaili Deng ◽

Sixia Chen ◽

...

Keyword(s):

Systematic Review ◽

Acinetobacter Baumannii ◽

Meta Analysis ◽

Predictors Of Mortality ◽

Carbapenem Resistant

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The incidence and prevalence of hospital-acquired (carbapenem-resistant) Acinetobacter baumannii in Europe, Eastern Mediterranean and Africa: a systematic review and meta-analysis

Emerging Microbes & Infections ◽

10.1080/22221751.2019.1698273 ◽

2019 ◽

Vol 8 (1) ◽

pp. 1747-1759 ◽

Cited By ~ 9

Author(s):

Olaniyi Ayobami ◽

Niklas Willrich ◽

Thomas Harder ◽

Iruka N. Okeke ◽

Tim Eckmanns ◽

...

Keyword(s):

Systematic Review ◽

Acinetobacter Baumannii ◽

Eastern Mediterranean ◽

Meta Analysis ◽

Carbapenem Resistant ◽

Hospital Acquired

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Importance of control groups when delineating antibiotic use as a risk factor for carbapenem resistance, extreme-drug resistance, and pan-drug resistance in Acinetobacter baumannii and Pseudomonas aeruginosa: A systematic review and meta-analysis

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2018.05.017 ◽

2018 ◽

Vol 76 ◽

pp. 48-57 ◽

Cited By ~ 4

Author(s):

Cheryl Li Ling Lim ◽

Alvin Qijia Chua ◽

Jocelyn Qi Min Teo ◽

Yiying Cai ◽

Winnie Lee ◽

...

Keyword(s):

Systematic Review ◽

Pseudomonas Aeruginosa ◽

Drug Resistance ◽

Risk Factor ◽

Acinetobacter Baumannii ◽

Meta Analysis ◽

Carbapenem Resistance ◽

Antibiotic Use ◽

Control Groups ◽

Extreme Drug Resistance

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Subtypes, resistance and virulence platforms in extended-drug resistant Acinetobacter baumannii Romanian isolates

Scientific Reports ◽

10.1038/s41598-021-92590-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Irina Gheorghe ◽

Ilda Czobor Barbu ◽

Marius Surleac ◽

Ionela Sârbu ◽

Laura Ioana Popa ◽

...

Keyword(s):

Acinetobacter Baumannii ◽

Carbapenem Resistance ◽

Control Measures ◽

Drug Resistant ◽

Infection Control Measures ◽

Carbapenem Resistant ◽

Ambulatory Patients ◽

Severe Infections ◽

Healthcare Associated ◽

Sequence Types

AbstractAcinetobacter baumannii has emerged worldwide as a dominant pathogen in a broad range of severe infections, raising an acute need for efficient antibacterials. This is the first report on the resistome and virulome of 33 extended drug-resistant and carbapenem-resistant A. baumannii (XDR CRAB) strains isolated from hospitalized and ambulatory patients in Bucharest, Romania. A total of 33 isolates were collected and analyzed using phenotypic antibiotic susceptibility and conjugation assays, PCR, whole-genome sequencing (WGS), pulsed-field gel electrophoresis (PFGE) and MultiLocus Sequence Typing (MLST). All isolates were extensively drug-resistant (XDR), being susceptible only to colistin. The carbapenem resistance was attributed by PCR mainly to blaOXA-24 and blaOXA-23 genes. PFGE followed by MLST analysis demonstrated the presence of nine pulsotypes and six sequence types. WGS of seven XDR CRAB isolates from healthcare-associated infections demonstrated the high diversity of resistance genes repertoire, as well as of mobile genetic elements, carrying ARGs for aminoglycosides, sulphonamides and macrolides. Our data will facilitate the understanding of resistance, virulence and transmission features of XDR AB isolates from Romanian patients and might be able to contribute to the implementation of appropriate infection control measures and to develop new molecules with innovative mechanisms of action, able to fight effectively against these bugs, for limiting the spread and decreasing the infection rate and mortality.

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