Prevalence of Integrons and Antibiotic Resistance Pattern in Acinetobacter baumannii Isolated from Clinical Samples of Iranian Patients A Systematic Review and Meta-analysis

Abstract

BACKGROUND: Acinetobacter baumannii is an importantopportunistic nosocomial pathogen. Class 1 integrons in A.baumannii plays a significant role in antibiotic resistance.Therefore, this study aimed to investigate the prevalence ofintegrons and antibiotic resistance pattern in A. baumannii isolatedfrom clinical samples of Iranian patients.METHODS: The Medical Subject Headings (MeSH) and thekeywords with the help of Boolean operators (“AND” or “OR”)were used alone or in combination to conduct the search. Thesearching process was conducted in the Web of Science, PubMed,Cochrane Library, Scopus, and Google Scholar databases and, alsoIranian databases. The search was restricted to relevant Englishand Persian cross-sectional publications reporting the prevalenceof Int1 in A. baumannii isolated from clinical samples from 1January 2000 to 31 December 2018. The data were analyzed usingComprehensiveMeta-Analysissoftware.Regardingtheheterogeneity of studies, the random effects model was used.Cochrane Q and I 2 tests was used to evaluate statisticalheterogeneity between the studies.RESULTS: Fifteen studies were included in the analysis. Thecombined prevalence of class 1 integrons in A. baumannii was55.2% (95% CI: 44.8-65.1). The pooled prevalence of MDR A.baumannii isolates was 68.1%. The highest resistance belonged toAztreonam, followed by Ciprofloxacin, and Ceftazidime with aresistance rate of 97.6%, 92.8%, and 91.6%, respectively.Tobramycin was reported as an effective antibiotic.CONCLUSIONS: The present study reported an alarmingly highprevalence of class 1 Integrons, and MDR isolates of A. baumanniirecovered from clinical samples that should be considered.