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Meta-Analysis
. 2023 Aug 15;23(1):534.
doi: 10.1186/s12879-023-08508-1.

Prevalence of gram-negative bacteria and their antibiotic resistance in neonatal sepsis in Iran: a systematic review and meta-analysis

Nazila Moftian  1 , Peyman Rezaei-Hachesu  1 , Morteza Arab-Zozani  2 , Taha Samad-Soltani  1 , Atefeh Esfandiari  3 , Mohammad Saleh Tabib  4 , Kayvan Mirnia  5
Affiliations
Meta-Analysis

Prevalence of gram-negative bacteria and their antibiotic resistance in neonatal sepsis in Iran: a systematic review and meta-analysis

Nazila Moftian et al. BMC Infect Dis. .

Abstract

Background: Neonatal sepsis, particularly gram-negative (GN) bacteria-induced, is a significant cause of morbidity and mortality in newborns. Healthcare professionals find this issue challenging because of antibiotic resistance. This study aims to combine findings to identify the prevalence of GN bacteria and their antibiotic resistance in Iranian neonates with sepsis.

Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The literature search was performed through international databases, including (PubMed/MEDLINE, EMBASE, Scopus, and Web of Science), Iranian local databases (Magiran, Iranmedex, Irandoc, Scimed, and SID), and the first 100 records of Google Scholar. Analytical cross-sectional study checklist from the Joanna Briggs Institute (JBI) was used for the quality assessment of included studies. Comprehensive Meta-Analysis Software Version 2 was used to conduct the meta-analysis. The between-study heterogeneity was investigated by I2 statistics.

Results: The prevalence of GN bacteria was estimated to be 53.6% [95% CI: 45.9- 61.1: P = 0.362] in Iranian neonates with sepsis, based on 31 studies with a sample size of 104,566. klebsiella pneumoniae (K.pneumonia) (23.2% [95% CI: 17.5-30.0, P < 0.001]) followed by Escherichia coli (E.coli) (13.5% [95% CI: 9.4-18.9, P < 0.001]) were more prevalent among GN bacteria. The highest resistance in K.pneumoniae was observed in Cefixime (80.6%, [95% CI: 56.3-93.1, P = 0.018]). E.coli showed greater resistance to Ampicillin (61.8%, [95% CI: 44.2-76.5, P = 0.188]. The prevalence of GN bacteria in Iranian neonates with sepsis has a decreasing trend based on the year, as shown by a meta-regression model (P < 0.0004).

Conclusion: GN pathogens, particularly K.pneumoniae, and E.coli, are the leading cause of neonatal sepsis in Iran. GN bacteria showed the highest resistance to Third-generation cephalosporin and Aminoglycosides.

Keywords: Antibiotic resistance; Gram-negative bacteria; Infection diseases; Morbidity; Neonatal sepsis; Prevalence rate; Systematic review or meta-analysis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The follow diagram of the literature selection process
Fig. 2
Fig. 2
Prevalence of Gram Negative bacteria in neonates with sepsis in Iran
Fig. 3
Fig. 3
Sensitivity analysis for the prevalence of Gram Negative bacteria in neonates with sepsis in Iran
Fig. 4
Fig. 4
Prevalence of antibiotic resistant in Gram-negative bacteria among neonates with sepsis in Iran
Fig. 5
Fig. 5
Prevalence of antimicrobial resistance on gram negative bacteria based on geographic region
Fig. 6
Fig. 6
Meta-regression model for the prevalence of gram negative bacteria in neonates with sepsis according to the published year of studies
Fig. 7
Fig. 7
Funnel plot for investigating of publication bias in the included studies
See this image and copyright information in PMC

References

    1. Amuka JI, Asogwa FO, Ugwuanyi RO, Onyechi T. Neonatal deaths and challenges of public health: where do we need urgent intervention in developing countries? Health Care Women Int. 2020;41(2):227–237. - PubMed
    1. Randolph AG, McCulloh RJ. Pediatric sepsis: important considerations for diagnosing and managing severe infections in infants, children, and adolescents. Virulence. 2014;5(1):179–189. - PMC - PubMed
    1. Tsai MH, Wu IH, Lee CW, Chu SM, Lien R, Huang HR, Chiang MC, Fu RH, Hsu JF, Huang YC. Neonatal gram-negative bacillary late-onset sepsis: a case-control-control study on a prospectively collected database of 5,233 admissions. Am J Infect Control. 2016;44(2):146–153. - PubMed
    1. World Health O . Global action plan on antimicrobial resistance. Geneva: World Health Organization; 2015.
    1. Wen SCH, Ezure Y, Rolley L, Spurling G, Lau CL, Riaz S, Paterson DL, Irwin AD. Gram-negative neonatal sepsis in low- and lower-middle-income countries and WHO empirical antibiotic recommendations: a systematic review and meta-analysis. PLoS Med. 2021;18(9):e1003787. - PMC - PubMed

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