Carbapenem-Resistant Klebsiella Pneumoniae in Iran: a Systematic Review and Meta-Analysis

Low Prevalence of Carbapenem-Resistant Klebsiella pneumoniae in Zabol, Southeast of Iran

“…Furthermore, resistance to ciprofloxacin and gentamicin in different provinces of Iran differed greatly, ranging from 12% to 53% and 6% to 59%, respectively. 14 Internationally, resistance to different classes of antibiotics such as beta-lactam and aminoglycoside in the majority of European countries such as Denmark, Finland, Sweden, Germany, and Norway are much lower compared to Iran. 14 These differences may be attributed to the low quality of personal hygiene, the indiscriminate use of antibiotics, infection control policies, and the presence of some risk factors such as previous hospitalization and long-term staying at ICU.…”

“…14 These differences may be attributed to the low quality of personal hygiene, the indiscriminate use of antibiotics, infection control policies, and the presence of some risk factors such as previous hospitalization and long-term staying at ICU. 14,15 Since carbapenems are relatively resistant to hydrolysis by most β-lactamases, they are currently used to treat serious infections caused by multi-drug resistance bacteria, showing resistance against cephalosporins, penicillins, and β-lactam/β-lactamase inhibitor combinations. 16 CR isolates of K. pneumoniae are known to be associated with high mortality and morbidity rates due to limited available therapeutic alternatives, indicating the importance of detection strategies.…”

“…16 CR isolates of K. pneumoniae are known to be associated with high mortality and morbidity rates due to limited available therapeutic alternatives, indicating the importance of detection strategies. [14][15][16][17][18] Based on the results of the current study, 3 (4.3%) K. pneumoniae isolates were CRKP among which two of them were blaNDM positive. Moreover, a comprehensive meta-analysis conducted to estimate the prevalence of CRKP in different provinces of Iran indicated that 11% of the isolated K. pneumoniae were CR, ranging from 0.004 in Tehran to 58% in Isfahan provinces.…”

“…15 These contradictory results may be related to the low quality of personal hygiene, [14][15][16][17][18] variable sample sizes, the indiscriminate use of antibiotics, poor infection control policies, and the presence of some risk factors like previous hospitalization and long-term staying at ICU. [14][15][16][17][18] The results of the current study further revealed that 4.3% of isolates were MBL enzymes positive using imipenem-EDTA combined disk test. Among them, two isolates were blaNDM positive while the other investigated resistance genes were not detected.…”

“…Class B beta-lactamases (i.e., blaVIM, blaIMP, blaNDM, and blaSPM), which include MBLs, are among the most essential mechanisms. [14][15][16][17][18][19] The findings of different independent studies demonstrated that plasmid-expressed blaNDM-1 gene encoding the NDM-1 metallo-β-lactamase is spreading worldwide. For example, different outbreaks of blaNDM producing isolates are reported from patients referring to hospitals in India, Pakistan, Bangladesh, Poland, the US, Canada, and Spain.…”