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

Mehran Ghazalibina
Hamed Mortazavi
Mahtab Babadi
Mohammadreza Rahimi
Azad Khaledi
Manouchehr Teymouri
Ehsan Saburi


BACKGROUND: Acinetobacter baumannii is an important opportunistic nosocomial pathogen. Class 1 integrons in A. baumannii plays a significant role in antibiotic resistance. Therefore, this study aimed to investigate the prevalence of integrons and antibiotic resistance pattern in A. baumannii isolated from clinical samples of Iranian patients.
METHODS: The Medical Subject Headings (MeSH) and the keywords with the help of Boolean operators (“AND” or “OR”) were used alone or in combination to conduct the search. The searching process was conducted in the Web of Science, PubMed, Cochrane Library, Scopus, and Google Scholar databases and, also Iranian databases. The search was restricted to relevant English and Persian cross-sectional publications reporting the prevalence of Int1 in A. baumannii isolated from clinical samples from 1 January 2000 to 31 December 2018. The data were analyzed using Comprehensive Meta-Analysis software. Regarding the heterogeneity of studies, the random effects model was used. Cochrane Q and I2 tests was used to evaluate statistical heterogeneity between the studies.
RESULTS: Fifteen studies were included in the analysis. The combined prevalence of class 1 integrons in A. baumannii was 55.2% (95% CI: 44.8-65.1). The pooled prevalence of MDR A.baumannii isolates was 68.1%. The highest resistance belonged to Aztreonam, followed by Ciprofloxacin, and Ceftazidime with a resistance rate of 97.6%, 92.8%, and 91.6%, respectively. Tobramycin was reported as an effective antibiotic.
CONCLUSIONS: The present study reported an alarmingly high prevalence of class 1 Integrons, and MDR isolates of A. baumannii recovered from clinical samples that should be considered.