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. 2023 May 5:10:1163439.
doi: 10.3389/fmed.2023.1163439. eCollection 2023.

Global prevalence and antibiotic resistance in clinical isolates of Stenotrophomonas maltophilia: a systematic review and meta-analysis

Maryam Banar  1 , Azin Sattari-Maraji  1 , Ghazal Bayatinejad  2 , Elahe Ebrahimi  3 , Leila Jabalameli  3 , Reza Beigverdi  2 , Mohammad Emaneini  2 , Fereshteh Jabalameli  2   4
Affiliations

Global prevalence and antibiotic resistance in clinical isolates of Stenotrophomonas maltophilia: a systematic review and meta-analysis

Maryam Banar et al. Front Med (Lausanne). .

Abstract

Introduction: Stenotrophomonas maltophilia is a little-known environmental opportunistic bacterium that can cause broad-spectrum infections. Despite the importance of this bacterium as an emerging drug-resistant opportunistic pathogen, a comprehensive analysis of its prevalence and resistance to antibiotics has not yet been conducted.

Methods: A systematic search was performed using four electronic databases (MEDLINE via PubMed, Embase, Scopus, and Web of Science) up to October 2019. Out of 6,770 records, 179 were documented in the current meta-analysis according to our inclusion and exclusion criteria, and 95 studies were enrolled in the meta-analysis.

Results: Present analysis revealed that the global pooled prevalence of S. maltophilia was 5.3 % [95% CI, 4.1-6.7%], with a higher prevalence in the Western Pacific Region [10.5%; 95% CI, 5.7-18.6%] and a lower prevalence in the American regions [4.3%; 95% CI, 3.2-5.7%]. Based on our meta-analysis, the highest antibiotic resistance rate was against cefuroxime [99.1%; 95% CI, 97.3-99.7%], while the lowest resistance was correlated with minocycline [4·8%; 95% CI, 2.6-8.8%].

Discussion: The results of this study indicated that the prevalence of S. maltophilia infections has been increasing over time. A comparison of the antibiotic resistance of S. maltophilia before and after 2010 suggested there was an increasing trend in the resistance to some antibiotics, such as tigecycline and ticarcillin-clavulanic acid. However, trimethoprim-sulfamethoxazole is still considered an effective antibiotic for treating S. maltophilia infections.

Keywords: Stenotrophomonas maltophilia; antibiotic resistance; global; meta-analysis; prevalence.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Summary of the literature search and study selection.
Figure 2
Figure 2
Forest plot diagram of the global prevalence rate of S. maltophilia isolation from clinical samples. The middle point of each line indicates the prevalence rate, and the length of the line indicates the 95% confidence interval of each study.
Figure 3
Figure 3
The global prevalence of S. maltophilia isolation based on the publication time of studies.
Figure 4
Figure 4
Prevalence of S. maltophilia isolated from clinical samples, by WHO regions.
Figure 5
Figure 5
The regional prevalence of S. maltophilia isolation based on the publication time of studies.
Figure 6
Figure 6
Comparison of the global antibiotic resistance rates of S. maltophilia before and after 2010 (SXT, trimethoprim-sulfamethoxazole; MNO, minocycline; LEV, levofloxacin; C, chloramphenicol; CAZ, ceftazidime; CIP, ciprofloxacin; TGC, tigecycline; CS, colistin; TTC, ticarcillin-clavulanic acid; FEP, cefepime; MRP, meropenem; IMI, imipenem; AK, amikacin; GN, gentamicin; TZP, piperacillin-tazobactam; CTX, cefotaxime).
Figure 7
Figure 7
Prevalence of trimethoprim/sulfamethoxazole resistance in S. maltophilia isolated from clinical samples, by WHO regions.
Figure 8
Figure 8
Prevalence of levofloxacin resistance in S. maltophilia isolated from clinical samples, by WHO regions.
Figure 9
Figure 9
Prevalence of minocycline resistance in S. maltophilia isolated from clinical samples, by WHO regions.
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