Systematic surveillance and meta-analysis on the prevalence of metallo-β-lactamase producers among carbapenem resistant clinical isolates in Pakistan. (December 2020)

• Record Type: Journal Article
• Authors: Ain, Noor ul; Abrar, Samyyia; Sherwani, Rehan Ahmad Khan; Hannan, Abdul; Imran, Namrah; Riaz, Saba
• Is Part Of: Journal of global antimicrobial resistance. Volume 23(2020)
• Page Start: 55
• Page End: 63
• Publication Date: 2020-12
• Subjects: CR carbapenem resistance -- CDST combination disk test -- DDST double disk synergism test -- E-Test epsilometric test -- MBL metallo-β-lactamases -- MHT Modified Hodge Test -- MIC minimum inhibitory concentration -- NDM New Delhi metallo-β-lactamase; Metallo-β-lactamases -- Carbapenem resistance -- Meta-analysis -- New Delhi Metallo-β-lactamase (NDM); Drug resistance -- Periodicals; Drug resistance -- Periodicals; Drug resistance; Periodicals; 616.9041
• DOI: 10.1016/j.jgar.2020.07.024
• Languages: English
• ISSNs: 2213-7165

Abstract

Highlights: A comprehensive study was successfully conducted to evaluate the prevalence of CR and MBLs for Pakistan. 110 relevant studies were identified, 19 corresponds to meta-analysis of CR and 22 conforms to MBLs for determining the pooled rate at indigenous level using STATA version 14. Attention is needed to pre-plan a periodic surveillance, pharmacovigilance and infection control program with much appreciated research in future. Abstract: Background: Emergence of carbapenem resistance (CR) is a health concern of pertinent importance. Epidemiological surveillance of CR at global and indigenous level (Pakistan) can help to improve infection control and establish pharmacovigilance programs. This study evaluates the prevalence of clinically significant CR isolates, and its genetic variant distribution among geographical regions of Pakistan. Methods: A meta-analysis was conducted to present the current rate of CR infections and prevalence of Metallo-β-lactamases (MBLs). The proposed subject was researched using electronic databases to identify the available literature. Thereafter, relevant data was extracted and statistical analysis was performed using STATA version 14. Results: A total of 110 relevant studies were identified with 19 meeting the inclusion criteria for the meta-analysis of CR, while 22 for MBLs. Pooled rate for carbapenem resistance was determined to be 0.28 (95% CI: 0.26–0.31) with overall significant heterogeneity ( I 2 = 99.61%, P < 0.001) and significant estimated score ES = 0 ( Z = 22.65, P < 0.001). In Pakistan, the pooled proportion of MBL producers was 0.34 (95% CI: 0.29–0.39) with overall heterogeneity significance ( I 2 = 99.62%, P < 0.001) and significant ES = 0 ( Z = 13.17, P < 0.001). Conclusion: Conclusively, diverse variants of carbapenemases (VIM, IMP, NDM, KPC, GIM) along with other β-lactamase variants (OXA, TEM, SHV, CTX-M) have been reported across the country. However, New Delhi Metallo-β-lactamase (NDM)-variants were reported in predominant literature. The prevalence of CR isolates in Pakistan is alarming, associated with MBL production primarily evident from the studies. The study emphasizes the need for regular surveillance, pharmacovigilance and antibiotic stewardship programs to ensure the availability of data to the authorities for preemptive measures of infection control.