PDF(Pubmed)
Abstract：
UNASSIGNED: Carbapenem resistance is epidemic worldwide, these last resort antimicrobials are listed in the WHO \'watch group\' with higher resistance potential. During the years 2017-18 Pakistan Antimicrobial Resistance Surveillance System reported an increase in carbapenem resistance. However, a comprehensive information on prevalence and molecular epidemiology of carbapenem resistance in Pakistan is not available. This systematic review and meta-analysis is aimed to report the current carbapenem resistance situation in Pakistan and its treatment options.
UNASSIGNED: In this systematic review and meta-analysis, we investigated the pooled prevalence (PPr) of carbapenem resistance in Enterobacteriaceae and non-Enterobacteriaceae by organizing available data, from Web of Science and PubMed by April 2, 2020, in various groups and subgroups including species, years, provinces, extended spectrum β-lactamase production, clinical presentation, carbapenemase and metallo-β-lactamase production, and New Delhi metallo-β-lactamase (NDM) prevalence. Literature review was updated for the studies publisehd by December 07, 2023. Moreover, we descriptively reviewed the molecular epidemiology of carbapenem resistance in Enterobacteriaceae and non-Enterobacteriaceae in Pakistan. Lastly, we statistically explored different treatment options available for carbapenem resistant infections. We used R package \'metafor\' for performing meta-analysis and influence diagnostics and determining treatment options.
UNASSIGNED: From two academic databases Web of Science and PubMed we identified 343 studies. Eighty-eight studies were selected for the systematic review and meta-analysis. Seventy-four studies were selected for phenotypic analysis, 36 for genotypic analysis, and 31 for available treatment options. PPr-ID of 12% [0.12 (0.07, 0.16)] was observed for phenotypic carbapenem resistance in Enterobacteriaceae with more prevalence recorded in Klebsiella pneumoniae 24% [0.24 (0.05, 0.44)] followed by 9% [0.09 (-0.03, 0.20)] in Escherichia coli. During the last two decades we observed a striking increase in carbapenem resistance PPr i.e., from 0% [0.00 (-0.02, 0.03)] to 36% [0.36 (0.17, 0.56)]. blaNDM with PPr 15% [0.15 (0.06, 0.23)] in naive isolates was found to be the fundamental genetic determinant for carbapenem resistance in Enterobacteriaceae in Pakistan. Polymyxin B, colistin, tigecycline, and fosfomycin were identified as the suggested treatment options available for multidrug resistant infections not responding to carbapenems. Various studies reported carbapenem resistance from human, animal, and environment sources.
UNASSIGNED: In conclusion, we found that NDM-1 producing carbapenem resistant Enterobacteriaceae are increasing in Pakistan. Meta-analysis showed that metallo-β-lactamases producing E. coli ST405 and K. pneumoniae sequence type11 are the major resistant clones. Number of reported studies in various subgroups and inconsistency in following CLSI guidelines are the potential limitations of this meta-analysis. A National antimicrobial resistance (AMR) surveillance strategy based on One Health is urgently needed to check any future AMR crisis in Pakistan.
UNASSIGNED: In this systematic review and meta-analysis, we investigated the pooled prevalence (PPr) of carbapenem resistance in Enterobacteriaceae and non-Enterobacteriaceae by organizing available data, from Web of Science and PubMed by April 2, 2020, in various groups and subgroups including species, years, provinces, extended spectrum β-lactamase production, clinical presentation, carbapenemase and metallo-β-lactamase production, and New Delhi metallo-β-lactamase (NDM) prevalence. Literature review was updated for the studies publisehd by December 07, 2023. Moreover, we descriptively reviewed the molecular epidemiology of carbapenem resistance in Enterobacteriaceae and non-Enterobacteriaceae in Pakistan. Lastly, we statistically explored different treatment options available for carbapenem resistant infections. We used R package \'metafor\' for performing meta-analysis and influence diagnostics and determining treatment options.
UNASSIGNED: From two academic databases Web of Science and PubMed we identified 343 studies. Eighty-eight studies were selected for the systematic review and meta-analysis. Seventy-four studies were selected for phenotypic analysis, 36 for genotypic analysis, and 31 for available treatment options. PPr-ID of 12% [0.12 (0.07, 0.16)] was observed for phenotypic carbapenem resistance in Enterobacteriaceae with more prevalence recorded in Klebsiella pneumoniae 24% [0.24 (0.05, 0.44)] followed by 9% [0.09 (-0.03, 0.20)] in Escherichia coli. During the last two decades we observed a striking increase in carbapenem resistance PPr i.e., from 0% [0.00 (-0.02, 0.03)] to 36% [0.36 (0.17, 0.56)]. blaNDM with PPr 15% [0.15 (0.06, 0.23)] in naive isolates was found to be the fundamental genetic determinant for carbapenem resistance in Enterobacteriaceae in Pakistan. Polymyxin B, colistin, tigecycline, and fosfomycin were identified as the suggested treatment options available for multidrug resistant infections not responding to carbapenems. Various studies reported carbapenem resistance from human, animal, and environment sources.
UNASSIGNED: In conclusion, we found that NDM-1 producing carbapenem resistant Enterobacteriaceae are increasing in Pakistan. Meta-analysis showed that metallo-β-lactamases producing E. coli ST405 and K. pneumoniae sequence type11 are the major resistant clones. Number of reported studies in various subgroups and inconsistency in following CLSI guidelines are the potential limitations of this meta-analysis. A National antimicrobial resistance (AMR) surveillance strategy based on One Health is urgently needed to check any future AMR crisis in Pakistan.
摘要：
■碳青霉烯类耐药性在全球范围内流行，这些最后的抗微生物药物被列入世卫组织“观察组”，具有更高的耐药性。在2017-18年期间，巴基斯坦抗菌素耐药性监测系统报告碳青霉烯耐药性增加。然而,目前尚无巴基斯坦碳青霉烯类耐药流行率和分子流行病学的全面信息.本系统评价和荟萃分析旨在报告巴基斯坦目前的碳青霉烯类耐药情况及其治疗方案。
■在本系统综述和荟萃分析中，我们通过整理现有数据调查了肠杆菌科和非肠杆菌科碳青霉烯耐药性的合并患病率（PPr），从WebofScience和PubMed到2020年4月2日，在包括物种在内的各种群体和亚组中，年,各省,广谱β-内酰胺酶生产，临床表现,碳青霉烯酶和金属-β-内酰胺酶的生产，和新德里金属β-内酰胺酶（NDM）患病率。到2023年12月7日，文献综述已更新。此外，我们描述性地回顾了巴基斯坦肠杆菌科和非肠杆菌科碳青霉烯类耐药的分子流行病学.最后,我们从统计学上探讨了碳青霉烯类耐药感染的不同治疗方案.我们使用R包“metafor”进行荟萃分析，影响诊断和确定治疗方案。
■从WebofScience和PubMed两个学术数据库中，我们确定了343项研究。选取88项研究进行系统评价和荟萃分析。选择了74项研究进行表型分析，36用于基因型分析，和31为可用的治疗选择。在肠杆菌科中观察到PPr-ID为12％[0.12（0.07，0.16）]的表型碳青霉烯耐药性，在肺炎克雷伯菌中记录的患病率更高24％[0.24（0.05，0.44）]，其次是9％[0.09（-0.03，0.20）]在大肠杆菌中。在过去的二十年中，我们观察到碳青霉烯抗性PPr的显着增加，即从0%[0.00（-0.02，0.03）]至36%[0.36（0.17，0.56）]。在幼稚分离株中具有PPr15％[0.15（0.06，0.23）]的blaNDM被发现是巴基斯坦肠杆菌科碳青霉烯耐药性的基本遗传决定因素。多粘菌素B,粘菌素,替加环素,和磷霉素被确定为对碳青霉烯类药物无反应的多药耐药感染的建议治疗方案。各种研究报道了人类对碳青霉烯的耐药性，动物,和环境来源。
■总而言之，我们发现，在巴基斯坦，产生NDM-1的碳青霉烯类耐药肠杆菌科细菌正在增加。Meta分析表明，产金属β-内酰胺酶的大肠杆菌ST405和肺炎克雷伯菌11型是主要的耐药克隆。在不同亚组中报告的研究数量和遵循CLSI指南的不一致是该荟萃分析的潜在局限性。迫切需要基于“一个健康”的国家抗菌素耐药性（AMR）监测策略，以检查巴基斯坦未来的AMR危机。
■在本系统综述和荟萃分析中，我们通过整理现有数据调查了肠杆菌科和非肠杆菌科碳青霉烯耐药性的合并患病率（PPr），从WebofScience和PubMed到2020年4月2日，在包括物种在内的各种群体和亚组中，年,各省,广谱β-内酰胺酶生产，临床表现,碳青霉烯酶和金属-β-内酰胺酶的生产，和新德里金属β-内酰胺酶（NDM）患病率。到2023年12月7日，文献综述已更新。此外，我们描述性地回顾了巴基斯坦肠杆菌科和非肠杆菌科碳青霉烯类耐药的分子流行病学.最后,我们从统计学上探讨了碳青霉烯类耐药感染的不同治疗方案.我们使用R包“metafor”进行荟萃分析，影响诊断和确定治疗方案。
■从WebofScience和PubMed两个学术数据库中，我们确定了343项研究。选取88项研究进行系统评价和荟萃分析。选择了74项研究进行表型分析，36用于基因型分析，和31为可用的治疗选择。在肠杆菌科中观察到PPr-ID为12％[0.12（0.07，0.16）]的表型碳青霉烯耐药性，在肺炎克雷伯菌中记录的患病率更高24％[0.24（0.05，0.44）]，其次是9％[0.09（-0.03，0.20）]在大肠杆菌中。在过去的二十年中，我们观察到碳青霉烯抗性PPr的显着增加，即从0%[0.00（-0.02，0.03）]至36%[0.36（0.17，0.56）]。在幼稚分离株中具有PPr15％[0.15（0.06，0.23）]的blaNDM被发现是巴基斯坦肠杆菌科碳青霉烯耐药性的基本遗传决定因素。多粘菌素B,粘菌素,替加环素,和磷霉素被确定为对碳青霉烯类药物无反应的多药耐药感染的建议治疗方案。各种研究报道了人类对碳青霉烯的耐药性，动物,和环境来源。
■总而言之，我们发现，在巴基斯坦，产生NDM-1的碳青霉烯类耐药肠杆菌科细菌正在增加。Meta分析表明，产金属β-内酰胺酶的大肠杆菌ST405和肺炎克雷伯菌11型是主要的耐药克隆。在不同亚组中报告的研究数量和遵循CLSI指南的不一致是该荟萃分析的潜在局限性。迫切需要基于“一个健康”的国家抗菌素耐药性（AMR）监测策略，以检查巴基斯坦未来的AMR危机。
