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Review
. 2018 Nov 15:9:177-188.
doi: 10.2147/AHMT.S180489. eCollection 2018.

Prevalence of vancomycin resistance among isolates of enterococci in Iran: a systematic review and meta-analysis

Abbas Moghimbeigi  1   2 , Meisam Moghimbeygi  3 , Majid Dousti  4 , Faezeh Kiani  5 , Fatemeh Sayehmiri  6 , Nourkhoda Sadeghifard  7 , Ali Nazari  8
Affiliations
Review

Prevalence of vancomycin resistance among isolates of enterococci in Iran: a systematic review and meta-analysis

Abbas Moghimbeigi et al. Adolesc Health Med Ther. .

Abstract

Introduction: Enterococcus is responsible for 10% of hospital-acquired infections. The purpose of this review was to evaluate the prevalence of vancomycin-resistant Enterococcus (VRE) isolates in Iran using a meta-analysis method.

Materials and methods: Iranian databases, including Magiran and IranDoc, and international databases, including PubMed and MedLib, were examined carefully, and a total of 20 articles published between 2000 and 2011 were extracted. The data were subjected to meta-analysis and random-effects models. In addition, heterogeneous studies were assessed using the I 2 index. Finally, the data were analyzed using R and STATA software.

Results: The results showed that the strain of Enterococcus faecalis had been more common than Enterococcus faecium in clinical infection (69% vs 28%). However, resistance to vancomycin was higher among strains of E. faecium compared with strains of E. faecalis (33% vs 3%). The complete resistance, intermediate resistance, and sensitivity to vancomycin among Enterococcus isolates were 14% (95% CI: 11, 18), 14% (95% CI: 5, 23), and 74% (95% CI: 65, 83), respectively. The resistance patterns, depending on the sample type, did not show a significant difference. In addition, the resistance of isolated strains to vancomycin in outpatients was significantly higher than that in inpatients (16% vs 1%). Moreover, 80%-86% of resistant strains were genotype van A and 14%-20% of resistant strains were genotype van B.

Conclusion: The findings of the present review show that there is a high frequency of resistant Enterococcus in Iran. Therefore, consideration of the prevalence and frequency of subjected resistant strains can be helpful for decision makers to implement proper health policies in this direction.

Keywords: antibiotic resistance; clinical infections; enterococci; glycopeptide antibiotics; gram-positive bacteria.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of the studies identified in the systematic review and meta-analysis.
Figure 2
Figure 2
Frequency of resistance and sensitivity to vancomycin in Enterococcus isolates. Abbreviations: E. faecalis, Enterococcus faecalis; E. faecium, Enterococcus faecium.
Figure 3
Figure 3
The prevalence of vancomycin resistance in Enterococcus isolates in Iran and its 95% CI in the reviewed studies based on the author’s name and year of study. Notes: Each squares shows the estimation prevalence of each study. The diamond symbol shows the prevalence values in Iran in all studies. Weights are from random-effects analysis. Abbreviation: ES, effect size.
Figure 4
Figure 4
The prevalence of vancomycin resistance in Enterococcus isolates in Iran and its 95% CI according to sample type: 1) urine, 2) stool, and 3) other clinical samples. Note: Weights are from random-effects analysis. Abbreviation: ES, effect size.
See this image and copyright information in PMC

References

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