背景:囊性纤维化(CF)中的抗生素耐药性是众所周知的现象。然而,抗生素耐药性对CF的综合流行病学影响没有明确记录.所以,这项荟萃分析评估了碳青霉烯耐药率(亚胺培南,美罗培南,和多尼培南)在CF中基于出版日期(1979-2000年、2001-2010年和2011-2021年),大陆,病原体,和抗菌药物敏感性试验(AST)。方法:我们在PubMed中搜索了研究,Scopus,和WebofScience(至2021年4月)。使用STATA软件(14.0版)进行统计分析。结果:分析中包括的110项研究在25个国家进行,调查了与CF相关的13,324种病原体。亚胺培南的总体比例,美罗培南,CF中的多尼培南耐药性为43%(95%CI36-49),48%(95%CI40-57),28%(95%CI23-33),和45%(95%CI32-59),分别。我们的荟萃分析表明,亚胺培南的趋势,美罗培南,多尼培南耐药性随着时间的推移逐渐下降(1979-2021年)。这可能是由于这些抗生素随着时间的推移治疗CF病例的临床有效性有限。在与CF相关的机会病原体中,碳青霉烯类耐药率最高的是嗜麦芽窄食单胞菌,伯克霍尔德氏菌。,铜绿假单胞菌,和金黄色葡萄球菌。CF患者中铜绿假单胞菌对碳青霉烯耐药率最高和最低的是美罗培南(23%)和多尼培南(39%)。结论:我们发现碳青霉烯耐药趋势随着时间的推移(1979-2021年)有所下降。这可能是由于这些抗生素随着时间的推移治疗CF病例的临床有效性有限。应制定计划以对抗生物膜相关感染并防止突变抗性的出现。需要通过分子监测对CF中产生碳青霉烯酶的病原体进行系统监测。
Background: Antibiotic resistance in cystic fibrosis (CF) is a well-known phenomenon. However, the comprehensive epidemiological impact of antibiotic resistance in CF is not clearly documented. So, this meta-analysis evaluated the proportion rates of carbapenem resistance (imipenem, meropenem, and doripenem) in CF based on publication date (1979-2000, 2001-2010, and 2011-2021), continents, pathogens, and antimicrobial susceptibility testing (AST). Methods: We searched studies in PubMed, Scopus, and Web of Science (until April 2021). Statistical analyses were conducted using STATA software (version 14.0). Results: The 110 studies included in the analysis were performed in 25 countries and investigated 13,324 pathogens associated with CF. The overall proportion of imipenem, meropenem, and doripenem resistance in CF were 43% (95% CI 36-49), 48% (95% CI 40-57), 28% (95% CI 23-33), and 45% (95% CI 32-59), respectively. Our meta-analysis showed that trends of imipenem, meropenem, and doripenem-resistance had gradual decreases over time (1979-2021). This could be due to the limited clinical effectiveness of these antibiotics to treat CF cases over time. Among the opportunistic pathogens associated with CF, the highest carbapenem resistance rates were shown in Stenotrophomonas maltophilia, Burkholderia spp., Pseudomonas aeruginosa, and Staphylococcus aureus. The highest and lowest carbapenem resistance rates among P. aeruginosa in CF patients were shown against meropenem (23%) and doripenem (39%). Conclusions: We showed that trends of carbapenem resistance had decreased over time (1979-2021). This could be due to the limited clinical effectiveness of these antibiotics to treat CF cases over time. Plans should be directed to fight biofilm-associated infections and prevent the emergence of mutational resistance. Systematic surveillance for carbapenemase-producing pathogens in CF by molecular surveillance is necessitated.