Antibiotic Resistance of Uropathogenic Escherichia coli (UPEC) among Iranian Pediatrics: Systematic Review and Meta-analysis
Abstract
Background: Uropathogenic Escherichia coli is a major cause of urinary tract infections (UTIs). This systematic review and meta-analysis was conducted to determine the prevalence of antibiotic-resistant uropathogenic E. coli among Iranian children with confirmed bacterial UTIs from 2012 to 2022.
Methods: A systematic review was performed by searching PubMed, Scopus, Google Scholar, Web of Science, MagIran, Iranian Scientific Information Database, IranMedex, and Iranian Research Institute for Information Science and Technology. The antibiotic-specific pooled prevalence estimates were calculated by applying a random-effects model. Freeman-Tukey Double Arcsine transformation was applied. I-squared statistic, and Cochran’s Q test were computed and meta-regression was conducted on latitude of sampling location.
Results: The literature search retrieved 2159 articles, among which 19 articles were included. The highest antibiotic resistance was related to doxycycline, ticarcillin-clavulanic acid, cefazolin, cefuroxime, and amoxycillin-clavulanic acid, 59%, 57%, 54%, 53%, and 52%, respectively. Meta-regression on the latitude was statistically significant for nitrofurantoin (P=0.05).
Conclusion: Resistant uropathogenic Escherichia coli strains were observed in the majority of confirmed bacterial UTIs among Iranian children. The most effective antibiotics for uropathogens were colistin, meropenem, and imipenem.
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2 Escherich T. Józef Brudziński–a pediatrician and neurologist. Available from: https://www.aotm.gov.pl/media/2022/06/9.Jozef-Brudzinski_final-na-strone.pdf
3. Kebede B, Yihunie W, Abebe D, Addis Tegegne B, Belayneh A (2022). Gram-negative bacteria isolates and their antibiotic-resistance patterns among pediatrics patients in Ethiopia: A systematic review. SAGE Open Med, 10:20503121221094191.
4. Kot B (2019). Antibiotic Resistance Among Uropathogenic. Pol J Microbiol, 68 (4):403-415.
5. Trześniewska-Ofiara Z, Mendrycka M, Cudo A, Szmulik M, Woźniak-Kosek A (2022). Hospital urinary tract infections in health care units on the example of Mazovian Specialist Hospital Ltd (MSH). Front Cell Infect Microbiol, 12:891796.
6. Sheykhsaran E, Ebrahimzadeh Leylabadlo H, Alinezhad F, Feizi H, Bannazadeh Baghi H (2022). A New Insight into Nosocomial Infections: a Worldwide Crisis. JoMMID, 10 (2):64-74.
7. Larsson D, Flach C-F (2022). Antibiotic resistance in the environment. Nat Rev Microbiol, 20 (5):257-269.
8. Kasew D, Desalegn B, Aynalem M, Tila S, Diriba D, Afework B, Getie M, Biset S, Baynes HW (2022). Antimicrobial resistance trend of bacterial uropathogens at the university of Gondar comprehensive specialized hospital, northwest Ethiopia: A 10 years retrospective study. PLoS One, 17 (4):e0266878.
9. Murray CJ, Ikuta KS, Sharara F, et al (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet, 399 (10325):629-655.
10. Dehbanipour R, Rastaghi S, Sedighi M, et al (2016). High prevalence of multidrug-resistance uropathogenic Escherichia coli strains, Isfahan, Iran. J Nat Sci Biol Med, 7 (1):22-6.
11. Iskandar K, Rizk R, Matta R, et al (2021). Economic burden of urinary tract infections from antibiotic-resistant Escherichia coli among hospitalized adult patients in Lebanon: a prospective cohort study. Value Health Reg Issues, 25:90-98.
12. Goodarzi R, Yousefimashouf R, Sedighi I, et al (2022). Detection of Adhesion Encoding Genes, Antibacterial Susceptibility Test and Biofilm Formation of Uropathogenic Escherichia coli Isolated from Urinary Tract Infections in Children. J Adv Med Biomed Res, 30 (138):47-53.
13. Kamaliaghdam M, Sadeghzadeh M, Jalilvand A, Eftekhari K, Rezaei Z (2020). Antibiotic sensitivity patterns of Escherichia coli isolated in urine samples of patients referred to Ayatollah Mousavi hospital in Zanjan. J Adv Med Biomed Res, 28 (128):124-131.
14. Yepes-Nuñez J, Urrutia G, Romero-Garcia M, Alonso-Fernandez S (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Revista Española de Cardiología, 74 (9):790-799.
15. Fakhri Demeshghieh A, Shokri A, Bokaie S. (2021). The prevalence of antibiotic-resistant uropathogenic Escherichia coli in Iranian children 2012-2022: a systematic review and meta-analysis. PROSPERO CRD42022300370. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022300370
16. Downes MJ, Brennan ML, Williams HC, Dean RS (2016). Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open, 6 (12):e011458.
17. Afsharpaiman S, Bairaghdar F, Torkaman M, et al (2012). Bacterial pathogens and resistance patterns in children with community-acquired urinary tract infection: a cross sectional study. Journal of Comprehensive Pediatrics, 3 (1):16-20.
18. Armin S, Fallah F, Hoseini-Alfatemi SM (2018). Antimicrobial susceptibility pattern of six threatening pathogens at Mofid Children’s Hospital, Tehran, Iran. Arch Clin Infect Dis, 13 (4) :e15576.
19. Behzadnia S, Davoudi A, Rezai MS, Ahangarkani F (2014). Nosocomial infections in pediatric population and antibiotic resistance of the causative organisms in north of iran. Iran Red Crescent Med J, 16 (2): e14562.
20. Ghadiri K, Akya A, Elahi A, Jafari S, Chegenelorestani R (2019). Evaluation of resistance to ciprofloxacin and identification of mutations in topoisomerase genes in Escherichia coli and Klebsiella pneumonia isolated from pediatric urinary tract infections. J Pediatr Res, 6 (4):322-328.
21. Goudarzi H, Aghamohammad S, Hashemi A, Nikmanesh B, Noori M (2013). Distribution of blaTEM, blaSHV and blaCTX-M genes among Escherichia coli isolates causing urinary tract infection in children. Arch Clin Infect Dis, 8(3): e16207
22. Habibian R, Khayyat Khameneie M, Sedighian H, et al (2014). Virulence factor diversity between imipenem resistant and imipenem susceptible strains of Escherichia coli isolated from hospitalized patients with severe urinary tract infections. Biosci Biotechnol Res Asia, 11 (2):469-477.
23. HedayatYaghoobi M, Karami P, Khaledi A, et al (2019). Comparison of antimicrobial resistance pattern in hospital versus community-acquired infections in pediatric patients. J Adv Med Biomed Res, 27 (123):1-8.
24. Mamishi S, Mahmoudi S, Naserzadeh N, et al (2019). Antibiotic resistance and genotyping of gram-negative bacteria causing hospital-acquired infection in patients referred to Children’s Medical Center. Infect Drug Resist, 12:3377-3384.
25. Mamishi S, Shalchi Z, Mahmoudi S, et al (2020). Antimicrobial resistance and genotyping of bacteria isolated from urinary tract infection in children in an Iranian referral hospital. Infect Drug Resist, 13:3317-3323.
26. Mansouri M, Afshar D, Hemati-Harsini M, Amir H (2015). Prevalence and microbial resistance of uropathogenic bacteria isolated from neonatal and pediatric patients in Western of Iran. Br Microbiol Res J, 10 (6):1-8.
27. Mashayekhi F, Moghny M, Faramarzpoor M, et al (2014). Molecular characterization and antimicrobial resistance of uropathogenic Escherichia coli. Iran J Biotechnol, 12 (2):32-40.
28. Dormanesh B, Mirnejad khodaverdi, Yahaghi Mommtaz, et al (2013). Investigation of virulence factors, determination of serogroups and antibiotic resistance of uropathogenic Escherichia coli strains isolated from children with pyelonephritis and cystitis. Iran J Med Microbiol, 7 (2):27-39.
29. Pouladfar G, Basiratnia M, Anvarinejad M, et al (2017). The antibiotic susceptibility patterns of uropathogens among children with urinary tract infection in Shiraz. Medicine (Baltimore), 96 (37): e7834.
30. Rajabi Z, Dallal MMS (2015). Study on bacterial strains causing blood and urinary tract infections in the neonatal Intensive Care Unit and determination of their antibiotic resistance pattern. Jundishapur J Microbiol, 8 (8):e19654.
31. Rezaee MA, Abdinia B (2015). Etiology and antimicrobial susceptibility pattern of pathogenic bacteria in children subjected to UTI: a referral hospital-based study in northwest of Iran. Medicine (Baltimore), 94 (39):e1606.
32. Salehi M, Amini K (2016). The frequency of fimbriae genes papA, fimH, kpsMT, papEF and ibeA in Escherichia coli isolated from children urinary tract infection. J Shahrekord Univ Med Sci, 18(5):73-82.
33. Shakibaie MR, Adeli S, Salehi MH (2014). Antimicrobial susceptibility pattern and ESBL production among uropathogenic Escherichia coli isolated from UTI children in pediatric unit of a hospital in Kerman, Iran. Br Microbiol Res J, 4 (3):262-271.
34. Taheri PA, Navabi B, Khatibi E (2013). Frequency and susceptibility of bacteria caused urinary tract infection in neonates: eight-year study at neonatal division of bahrami children’s hospital, Tehran Iran. Iran J Public Health, 42 (10):1126-1133.
35. Vakilzadeh MM, Heidari A, Mehri A, et al (2020). Antimicrobial resistance among community-acquired uropathogens in Mashhad, Iran. J Environ Public Health, 2020:3439497.
36. Alfuraiji N, Al-Hamami A, Ibrahim M, Rajab HK, Hussain BW (2022). Uropathogenic Escherichia coli virulence characteristics and antimicrobial resistance amongst pediatric urinary tract infections. J Med Life, 15 (5):650-654.
37. Yilmaz Y, Tazegun ZT, Aydin E, Dulger M (2016). Bacterial uropathogens causing urinary tract infection and their resistance patterns among children in Turkey. Iran Red Crescent Med J, 18 (6): e26610.
38. Hadifar S, Moghoofei M, Nematollahi S, et al (2017). Epidemiology of multidrug resistant uropathogenic Escherichia coli in Iran: a systematic review and meta-analysis. Jpn J Infect Dis, 70 (1):19-25.
39. Hrbacek J, Cermak P, Zachoval R (2020). Current antibiotic resistance trends of uropathogens in Central Europe: Survey from a Tertiary hospital urology department 2011–2019. Antibiotics (Basel), 9 (9):630.
40. Levy SB (2002). Factors impacting on the problem of antibiotic resistance. J Antimicrob Chemother, 49 (1):25-30.
2 Escherich T. Józef Brudziński–a pediatrician and neurologist. Available from: https://www.aotm.gov.pl/media/2022/06/9.Jozef-Brudzinski_final-na-strone.pdf
3. Kebede B, Yihunie W, Abebe D, Addis Tegegne B, Belayneh A (2022). Gram-negative bacteria isolates and their antibiotic-resistance patterns among pediatrics patients in Ethiopia: A systematic review. SAGE Open Med, 10:20503121221094191.
4. Kot B (2019). Antibiotic Resistance Among Uropathogenic. Pol J Microbiol, 68 (4):403-415.
5. Trześniewska-Ofiara Z, Mendrycka M, Cudo A, Szmulik M, Woźniak-Kosek A (2022). Hospital urinary tract infections in health care units on the example of Mazovian Specialist Hospital Ltd (MSH). Front Cell Infect Microbiol, 12:891796.
6. Sheykhsaran E, Ebrahimzadeh Leylabadlo H, Alinezhad F, Feizi H, Bannazadeh Baghi H (2022). A New Insight into Nosocomial Infections: a Worldwide Crisis. JoMMID, 10 (2):64-74.
7. Larsson D, Flach C-F (2022). Antibiotic resistance in the environment. Nat Rev Microbiol, 20 (5):257-269.
8. Kasew D, Desalegn B, Aynalem M, Tila S, Diriba D, Afework B, Getie M, Biset S, Baynes HW (2022). Antimicrobial resistance trend of bacterial uropathogens at the university of Gondar comprehensive specialized hospital, northwest Ethiopia: A 10 years retrospective study. PLoS One, 17 (4):e0266878.
9. Murray CJ, Ikuta KS, Sharara F, et al (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet, 399 (10325):629-655.
10. Dehbanipour R, Rastaghi S, Sedighi M, et al (2016). High prevalence of multidrug-resistance uropathogenic Escherichia coli strains, Isfahan, Iran. J Nat Sci Biol Med, 7 (1):22-6.
11. Iskandar K, Rizk R, Matta R, et al (2021). Economic burden of urinary tract infections from antibiotic-resistant Escherichia coli among hospitalized adult patients in Lebanon: a prospective cohort study. Value Health Reg Issues, 25:90-98.
12. Goodarzi R, Yousefimashouf R, Sedighi I, et al (2022). Detection of Adhesion Encoding Genes, Antibacterial Susceptibility Test and Biofilm Formation of Uropathogenic Escherichia coli Isolated from Urinary Tract Infections in Children. J Adv Med Biomed Res, 30 (138):47-53.
13. Kamaliaghdam M, Sadeghzadeh M, Jalilvand A, Eftekhari K, Rezaei Z (2020). Antibiotic sensitivity patterns of Escherichia coli isolated in urine samples of patients referred to Ayatollah Mousavi hospital in Zanjan. J Adv Med Biomed Res, 28 (128):124-131.
14. Yepes-Nuñez J, Urrutia G, Romero-Garcia M, Alonso-Fernandez S (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Revista Española de Cardiología, 74 (9):790-799.
15. Fakhri Demeshghieh A, Shokri A, Bokaie S. (2021). The prevalence of antibiotic-resistant uropathogenic Escherichia coli in Iranian children 2012-2022: a systematic review and meta-analysis. PROSPERO CRD42022300370. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022300370
16. Downes MJ, Brennan ML, Williams HC, Dean RS (2016). Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open, 6 (12):e011458.
17. Afsharpaiman S, Bairaghdar F, Torkaman M, et al (2012). Bacterial pathogens and resistance patterns in children with community-acquired urinary tract infection: a cross sectional study. Journal of Comprehensive Pediatrics, 3 (1):16-20.
18. Armin S, Fallah F, Hoseini-Alfatemi SM (2018). Antimicrobial susceptibility pattern of six threatening pathogens at Mofid Children’s Hospital, Tehran, Iran. Arch Clin Infect Dis, 13 (4) :e15576.
19. Behzadnia S, Davoudi A, Rezai MS, Ahangarkani F (2014). Nosocomial infections in pediatric population and antibiotic resistance of the causative organisms in north of iran. Iran Red Crescent Med J, 16 (2): e14562.
20. Ghadiri K, Akya A, Elahi A, Jafari S, Chegenelorestani R (2019). Evaluation of resistance to ciprofloxacin and identification of mutations in topoisomerase genes in Escherichia coli and Klebsiella pneumonia isolated from pediatric urinary tract infections. J Pediatr Res, 6 (4):322-328.
21. Goudarzi H, Aghamohammad S, Hashemi A, Nikmanesh B, Noori M (2013). Distribution of blaTEM, blaSHV and blaCTX-M genes among Escherichia coli isolates causing urinary tract infection in children. Arch Clin Infect Dis, 8(3): e16207
22. Habibian R, Khayyat Khameneie M, Sedighian H, et al (2014). Virulence factor diversity between imipenem resistant and imipenem susceptible strains of Escherichia coli isolated from hospitalized patients with severe urinary tract infections. Biosci Biotechnol Res Asia, 11 (2):469-477.
23. HedayatYaghoobi M, Karami P, Khaledi A, et al (2019). Comparison of antimicrobial resistance pattern in hospital versus community-acquired infections in pediatric patients. J Adv Med Biomed Res, 27 (123):1-8.
24. Mamishi S, Mahmoudi S, Naserzadeh N, et al (2019). Antibiotic resistance and genotyping of gram-negative bacteria causing hospital-acquired infection in patients referred to Children’s Medical Center. Infect Drug Resist, 12:3377-3384.
25. Mamishi S, Shalchi Z, Mahmoudi S, et al (2020). Antimicrobial resistance and genotyping of bacteria isolated from urinary tract infection in children in an Iranian referral hospital. Infect Drug Resist, 13:3317-3323.
26. Mansouri M, Afshar D, Hemati-Harsini M, Amir H (2015). Prevalence and microbial resistance of uropathogenic bacteria isolated from neonatal and pediatric patients in Western of Iran. Br Microbiol Res J, 10 (6):1-8.
27. Mashayekhi F, Moghny M, Faramarzpoor M, et al (2014). Molecular characterization and antimicrobial resistance of uropathogenic Escherichia coli. Iran J Biotechnol, 12 (2):32-40.
28. Dormanesh B, Mirnejad khodaverdi, Yahaghi Mommtaz, et al (2013). Investigation of virulence factors, determination of serogroups and antibiotic resistance of uropathogenic Escherichia coli strains isolated from children with pyelonephritis and cystitis. Iran J Med Microbiol, 7 (2):27-39.
29. Pouladfar G, Basiratnia M, Anvarinejad M, et al (2017). The antibiotic susceptibility patterns of uropathogens among children with urinary tract infection in Shiraz. Medicine (Baltimore), 96 (37): e7834.
30. Rajabi Z, Dallal MMS (2015). Study on bacterial strains causing blood and urinary tract infections in the neonatal Intensive Care Unit and determination of their antibiotic resistance pattern. Jundishapur J Microbiol, 8 (8):e19654.
31. Rezaee MA, Abdinia B (2015). Etiology and antimicrobial susceptibility pattern of pathogenic bacteria in children subjected to UTI: a referral hospital-based study in northwest of Iran. Medicine (Baltimore), 94 (39):e1606.
32. Salehi M, Amini K (2016). The frequency of fimbriae genes papA, fimH, kpsMT, papEF and ibeA in Escherichia coli isolated from children urinary tract infection. J Shahrekord Univ Med Sci, 18(5):73-82.
33. Shakibaie MR, Adeli S, Salehi MH (2014). Antimicrobial susceptibility pattern and ESBL production among uropathogenic Escherichia coli isolated from UTI children in pediatric unit of a hospital in Kerman, Iran. Br Microbiol Res J, 4 (3):262-271.
34. Taheri PA, Navabi B, Khatibi E (2013). Frequency and susceptibility of bacteria caused urinary tract infection in neonates: eight-year study at neonatal division of bahrami children’s hospital, Tehran Iran. Iran J Public Health, 42 (10):1126-1133.
35. Vakilzadeh MM, Heidari A, Mehri A, et al (2020). Antimicrobial resistance among community-acquired uropathogens in Mashhad, Iran. J Environ Public Health, 2020:3439497.
36. Alfuraiji N, Al-Hamami A, Ibrahim M, Rajab HK, Hussain BW (2022). Uropathogenic Escherichia coli virulence characteristics and antimicrobial resistance amongst pediatric urinary tract infections. J Med Life, 15 (5):650-654.
37. Yilmaz Y, Tazegun ZT, Aydin E, Dulger M (2016). Bacterial uropathogens causing urinary tract infection and their resistance patterns among children in Turkey. Iran Red Crescent Med J, 18 (6): e26610.
38. Hadifar S, Moghoofei M, Nematollahi S, et al (2017). Epidemiology of multidrug resistant uropathogenic Escherichia coli in Iran: a systematic review and meta-analysis. Jpn J Infect Dis, 70 (1):19-25.
39. Hrbacek J, Cermak P, Zachoval R (2020). Current antibiotic resistance trends of uropathogens in Central Europe: Survey from a Tertiary hospital urology department 2011–2019. Antibiotics (Basel), 9 (9):630.
40. Levy SB (2002). Factors impacting on the problem of antibiotic resistance. J Antimicrob Chemother, 49 (1):25-30.
| Files | ||
| Issue | Vol 53 No 3 (2024) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v53i3.15133 | |
| Keywords | ||
| Uropathogenic Escherichia coli Antibiotic resistance Pediatrics Urinary tract infection Pediatric | ||
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How to Cite
1.
Fakhri-Demeshghieh A, Shokri A, Bokaie S. Antibiotic Resistance of Uropathogenic Escherichia coli (UPEC) among Iranian Pediatrics: Systematic Review and Meta-analysis. Iran J Public Health. 2024;53(3):508-523.
