Prevalence of Class 1 Integron and Antibiotic Resistance Pattern in Pseudomonas aeruginosa Isolated from Iranian Clinical Specimens; a Systematic Review and Meta-Analysis

Abstract

Background The role of integrons has been shown in the horizontal transmission of antibiotic resistance genes among bacterial isolates especially Gram-negative microorganisms in clinical settings. Objectives The aim of this study was to systematically review the prevalence of class 1 integrons and antibiotic resistance in Pseudomonas aeruginosa isolates of clinical samples of Iranian patients. Methods The Web of Science, PubMed, Scopus, and Science Direct databases were searched using preferred keywords based on the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The cross-sectional studies addressing the frequency of class 1 integrons and antibiotic‑resistance in P. aeruginosa isolates from clinical samples of Iranian patients published from 1 January 2000 until 31 December 2018 were included. Meta-analysis was performed using Comprehensive Meta-Analysis¬ (CMA) software. The random effects model was used for meta-analysis. The Cochran’s Q and I2 tests were applied for statistical analyses. Publication bias was assessed using Funnel plot and Egger’s linear regression test. Results Out of 911 studies retrieved in the initial search, 17 articles met the eligibility standards for being included in the meta-analysis. The Egger’s linear regression test indicated no publication bias (P = 0.95). The combined prevalence of class 1 integrons in P. aeruginosa isolates was obtained as 58.9% (95% CI: 46.3–70.4%). The highest rate of combined antibiotic resistance was related to Carbenicillin with a resistance rate of 79.9%. On the other side, the most effective antibiotic against P. aeruginosa was Polymyxin B with the resistance rate of 0%. The pooled prevalence of multi-drug resistant (MDR) P. aeruginosa isolates was 55% (¬95% CI: 33.8-75.3%). Conclusions Our findings indicated the high prevalence of class 1 integrons and antibiotic resistance among P. aeruginosa isolates of Iranian patients’ clinical samples. Also, the prevalence of MDR P. aeruginosa isolates was noticeable requiring prompt action.

Evaluation of β-lactamases and Molecular Typing of Pseudomonas aeruginosa Clinical Strains Isolated from Hospitalized Children in Tehran, Iran

“…Still, none of the imipenem-resistant P. aeruginosa isolates harbored an insertions element in the OprD gene. As shown by several studies, alteration of OprD increases the MIC for imipenem but not other carbapenems (38,50). A different study by Wolter et al showed the presence of IS elements within the OprD gene, which was not observed in this study (51).…”

“…Among the present study's 80 clinical isolates of P. aeruginosa, 20% were resistant to carbapenems. The resistance range of P. aeruginosa to imipenem in other studies in different regions was 5.5 to 62.5% (25,(35)(36)(37)(38). Resistance to carbapenems in P. aeruginosa occurs via several mechanisms.…”