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Meta-Analysis
. 2023 Oct;117(7):611-622.
doi: 10.1080/20477724.2023.2179451. Epub 2023 Feb 16.

The increasing antimicrobial resistance of Shigella species among Iranian pediatrics: a systematic review and meta-analysis

Amirhossein Baharvand  1 , Leila Molaeipour  2 , Sogol Alesaeidi  3 , Reyhane Shaddel  4 , Noushin Mashatan  5 , Taghi Amiriani  6 , Melika Kiaei Sudkolaei  7 , Sara Abbasian  4 , Bashar Zuhair Talib Al-Naqeeb  8 , Ebrahim Kouhsari  4   9
Affiliations
Meta-Analysis

The increasing antimicrobial resistance of Shigella species among Iranian pediatrics: a systematic review and meta-analysis

Amirhossein Baharvand et al. Pathog Glob Health. 2023 Oct.

Abstract

Background: Shigellosis remains one of the global causes of morbidity and mortality. However, the global emergence of antibiotic resistance has become the leading cause of treatment failure in shigellosis. This review aimed to provide an updated picture of the antimicrobial resistance rates in Shigella species in Iranian pediatrics.

Methods: A comprehensive systematic search was performed on PubMed, Scopus, Embase, and Web of Science until 28 July 2021. The meta-analysis was performed by computing the pooled using a random-effects model with Stata/SE software, v.17.1. The discrepancy within articles was surveyed by the forest plot in addition to the I2 statistic. All statistical interpretations were reported on a 95% confidence interval (CI) basis.

Results: Totally, of 28 eligible studies published between 2008 and 2021. The pooled prevalence rate of multidrug-resistant (MDR) was 63% (95% CI 50-76). Regarding suggested antimicrobial agents for Shigella species, the prevalence of resistance for ciprofloxacin, azithromycin, and ceftriaxone as first- and second-line treatments for shigellosis were 3%, 30%, and 28%, respectively. In contrast, resistance to cefotaxime, cefixime, and ceftazidime was 39%, 35%, and 20%. Importantly, subgroup analyses indicated that an increase in resistance rates during the periods (2008-2014, 2015-2021) was recognized for ciprofloxacin (0 % to 6%) and ceftriaxone (6% to 42%).

Conclusion: Our findings revealed that ciprofloxacin is an effective drug for shigellosis in Iranian children. The substantially high prevalence estimation proposes that the first- and second-line treatments for shigellosis are the major threat to public health and active antibiotic treatment policies are essential.

Keywords: Antimicrobial resistance; Shigella species; resistance; systematic review and meta-analysis.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
The PRISMA flowchart of included studies.
Figure 2.
Figure 2.
Forest plots and DOI plots of the prevalence of clinical Shigella species resistant to ciprofloxacin (A) and azithromycin (B) in Iran.
Figure 3.
Figure 3.
Forest plots and DOI plots of the prevalence of clinical Shigella species resistant to ciprofloxacin (A) and azithromycin (B) in Iran.
Figure 4.
Figure 4.
The prevalence of ciprofloxacin, ceftriaxone, and cefixime weighted pooled resistance in Iranian children stratified by published year.
Figure 5.
Figure 5.
The prevalence of azithromycin, ciprofloxacin, ceftriaxone, and cefixime weighted pooled resistance in Iranian provinces.
See this image and copyright information in PMC

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