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Meta-Analysis
. 2024 Mar 19;23(1):26.
doi: 10.1186/s12941-024-00685-4.

Global mapping of antibiotic resistance rates among clinical isolates of Stenotrophomonas maltophilia: a systematic review and meta-analysis

Narjess Bostanghadiri  1   2 , Mohammad Sholeh  3 , Tahereh Navidifar  4 , Leila Dadgar-Zankbar  1 , Zahra Elahi  1 , Alex van Belkum  5 , Davood Darban-Sarokhalil  6
Affiliations
Meta-Analysis

Global mapping of antibiotic resistance rates among clinical isolates of Stenotrophomonas maltophilia: a systematic review and meta-analysis

Narjess Bostanghadiri et al. Ann Clin Microbiol Antimicrob. .

Abstract

Introduction: Infections caused by Stenotrophomonas maltophilia are clinically important due to its intrinsic resistance to a broad range of antibiotics. Therefore, selecting the most appropriate antibiotic to treat S. maltophilia infection is a major challenge.

Aim: The current meta-analysis aimed to investigate the global prevalence of antibiotic resistance among S. maltophilia isolates to the develop more effective therapeutic strategies.

Method: A systematic literature search was performed using the appropriate search syntax after searching Pubmed, Embase, Web of Science and Scopus databases (May 2023). Statistical analysis was performed using Pooled and the random effects model in R and the metafor package. A total of 11,438 articles were retrieved. After a thorough evaluation, 289 studies were finally eligible for inclusion in this systematic review and meta-analysis.

Result: Present analysis indicated that the highest incidences of resistance were associated with doripenem (97%), cefoxitin (96%), imipenem and cefuroxime (95%), ampicillin (94%), ceftriaxone (92%), aztreonam (91%) and meropenem (90%) which resistance to Carbapenems is intrinsic. The lowest resistance rates were documented for minocycline (3%), cefiderocol (4%). The global resistance rate to TMP-SMX remained constant in two periods before and after 2010 (14.4% vs. 14.6%). A significant increase in resistance to tigecycline and ceftolozane/tazobactam was observed before and after 2010.

Conclusions: Minocycline and cefiderocol can be considered the preferred treatment options due to low resistance rates, although regional differences in resistance rates to other antibiotics should be considered. The low global prevalence of resistance to TMP-SMX as a first-line treatment for S. maltophilia suggests that it remains an effective treatment option.

Keywords: Stenotrophomonas maltophilia; Antibiotic resistance; Global prevalence; Meta-analysis; Systematic review.

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Conflict of interest statement

The authors assert that the conducted investigation was devoid of any economic or monetary affiliations that could be perceived as a possible conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart of study selection for inclusion in the systematic review and meta-analysis
Fig. 2
Fig. 2
Forest plot of the global antibiotic resistance rates of S. maltophilia isolation from clinical samples
Fig. 3
Fig. 3
Prevalence of antibiotic resistance among S. maltophilia by continent
Fig. 4
Fig. 4
Comparison of antibiotic resistance among S. maltophilia strains stratified by continent of origin
Fig. 5
Fig. 5
Global antibiotic resistance rates of S. maltophilia during 1958–2010 and 2011–2023
Fig. 6
Fig. 6
Comparison of recommended antibiotic resistance among S. maltophilia around the world. SXT: Cotrimoxazole; LEV: Levofloxacin; MIN: Minocycline; CZA: Ceftazidime; TCC: Ticarcilin-Clavunic acid; FDC: Cefiderocol; CHL: Chloramphenicol
See this image and copyright information in PMC

References

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