Prevalence of extended-spectrum-β-lactamase-producing Klebsiella pneumonia: first systematic review and meta-analysis from Iran.

OBJECTIVES: Extended-spectrum β-lactamases- producing Klebsiella pneumonia (ESBL-KP) have emerged as an important pathogen causing severe infection thought the world. Infections due to ESBL-KP are associated with high morbidity and mortality, especially in developing countries such as Iran. The aim of current study was to assess the pooled prevalence of ESBL-KP with different gene variants in Iran.

METHODS: A literature search of the Medline (via PubMed), Embase, Web of Science, and Iranian Database was carried out. A meta-analysis was conducted using Comprehensive Meta-Analysis Software (BioStat v.2.2). A fixed- or random-effects model was performed based on a heterogeneity test. Publication bias was determined using Begg rank correlation and Egger weighted regression methods.

RESULTS: Among the 783 articles identified, 43 studies met eligibility criteria. The pooled prevalence of ESBL-KP was 43.5% (95% CI 39.3-47.9) in clinical isolates of K. pneumoniae. Among genes encoding ESBLs during 2000-2009, SHV, CTX-M and TEM were found with the prevalence of 23.3%, 15.2% and 12.3%, respectively. While, the prevalence of SHV, CTX-M, TEM and VEB was 24%, 28.1%, 12.3%, 25.2% and 8.3%) during the period 2010-2018, respectively.

CONCLUSION: The prevalence of ESBL-KP has increased steadily in recent years among clinical isolates of K. pneumoniae in Iran. Thereby, initial identification of ESBL-KP according to the Clinical Laboratory Standards Institute guidelines, proper molecular approaches and implementation of antimicrobial stewardship programs in Iranian hospitals together with comprehensive infection control measures are urgently needed to control the dissemination of these strains.