Systematic review and meta-analysis on the prevalence of extended-spectrum β-lactamases-producing Acinetobacter baumannii in Iran: Evaluation of TEM, PER, SHV, CTX-M, VEB and GES

Acinetobacter baumannii's resistance to antibiotics restricts treatment ways, and has enhanced its mortality rates approaching 35 %. Resistance to β-lactams in Acinetobacter baumannii, related to extended-spectrum β-lactamases (ESBLs), has become a worldwide concern. This study aimed to assess the prevalence of Extended-Spectrum Beta-Lactamase-Producing Acinetobacter baumannii in Iran.

Important databases (PubMed, Scopus, Wily Online Library, ScienceDirect and Google Scholar) were searched for related literature published from January 2010 to April 2024. The inclusion criteria were predefined based on PRISMA guidelines. A random-effects model was used according to the heterogeneity test. Publication bias was specified using Egger's weighted regression and Begg's rank correlation methods. The statistical analyses were carried out relying on the Comprehensive Meta-Analysis Software (CMA).

Among 2409 articles identified, 15 papers met the eligibility criteria. Among encoding genes of ESBLs, TEM, PER, SHV, CTX-M, VEB and GES were found with the prevalence of 25.0 % (95 % CI: 15.9–37.1 %), 16.1 % (95 % CI: 7.4–31.5 %), 14.3 % (95 % CI: 6.3–29.4 %), 11.1 % (95 % CI: 4.3–25.8 %), 9.9 % (95 % CI: 5.2–18.1 %) and 8.5 % (95 % CI: 1.4–37.2 %), respectively. A subgroup analysis based on province showed some differences in TEM prevalence. The evaluated pooled prevalence of TEM was highest in Ilam (53.4 %; 95 % CI: 42.0–64.5 %), however, it was based only on one study. It was 51.1 % (95 % CI: 33.7–68.3 %) in Tehran.

The present studies demonstrate a high prevalence of ESBL in Acinetobacter Baumannii in Iran which poses a serious concern in critically ill patients. As well as these findings can assist our conception of the real prevalence of ESBL to work on new strategies for the control and prevention of infection.