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Insights into Haemophilus macrolide resistance: A comprehensive systematic review and meta-analysis
Irfan Ahmad1, Aziz Kubaev2, Ahmed Hussein Zwamel3,4,5
1Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia.
Background:
Haemophilus spp., particularly Haemophilus influenzae, are major global pathogens causing various infections. Macrolides are crucial in treating these infections, but rising resistance to macrolides in Haemophilus spp. highlights the growing threat of antimicrobial resistance (AMR).
Objective:
This study aims to assess the prevalence of macrolide resistance in Haemophilus spp, across different global regions.
Methods:
A systematic literature search was conducted across PubMed, Embase, Web of Science, and Scopus databases from May 2015 to December 2023 to identify studies on macrolide resistance in Haemophilus spp. The review included English-language full-text articles that reported resistance proportions and sample sizes. Study quality was assessed using the JBI Critical Appraisal Tool. Statistical analysis was performed using a random-effects model using the metafor package in R.
Results:
A total of 10,114 articles were retrieved, and after a comprehensive evaluation, 15 studies (from 19 reports) met the eligibility criteria for inclusion in this systematic review and meta-analysis. Most studies (eight reports from three countries) focused on clarithromycin susceptibility, revealing a pooled prevalence of 7.2%. High heterogeneity was observed for azithromycin (I² = 96.31%, p < 0.001). Azithromycin resistance was higher than clarithromycin, with a resistance rate of 9.3% (nine reports), while erythromycin resistance was significantly higher at 79% (four reports). Subgroup analysis revealed significant variations in resistance prevalence based on geographic location and continent for azithromycin, erythromycin, and clarithromycin. Additionally, notable differences were observed in resistance rates depending on antimicrobial susceptibility testing (AST) methods and AST guidelines for both azithromycin and erythromycin. Clarithromycin resistance increased from 0.7% (2015-2019) to 12.6% (2020-2023).
Conclusion:
The study underscores the significant challenges of macrolide resistance in treating Haemophilus spp. infections. Additionally, ongoing surveillance of resistance patterns and exploring contributing factors are crucial to enhancing treatment effectiveness.
Insights
Macrolide resistance in Haemophilus spp. is a growing concern, with erythromycin resistance at 79% and clarithromycin resistance increasing significantly. Ongoing surveillance is vital for effective treatment strategies against these pathogens.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Haemophilus spp., particularly Haemophilus influenzae, are significant global pathogens.
- Macrolide antibiotics are essential for treating infections caused by these bacteria.
- Increasing macrolide resistance in Haemophilus spp. poses a substantial threat due to antimicrobial resistance (AMR).
Purpose of the Study:
- To systematically assess the global prevalence of macrolide resistance in Haemophilus spp.
- To analyze resistance patterns across different geographic regions and macrolide agents.
Main Methods:
- A systematic literature search was performed across major databases (PubMed, Embase, Web of Science, Scopus) from May 2015 to December 2023.
- Included were English-language full-text articles reporting resistance proportions and sample sizes for Haemophilus spp.
- Meta-analysis using a random-effects model was conducted to pool resistance prevalence data.
Main Results:
- Fifteen studies met the inclusion criteria, analyzing data from 19 reports.
- Pooled macrolide resistance prevalence: Clarithromycin 7.2%, Azithromycin 9.3%, Erythromycin 79%.
- Significant variations in resistance were observed by geographic region, continent, antimicrobial susceptibility testing (AST) methods, and guidelines. Clarithromycin resistance rose from 0.7% (2015-2019) to 12.6% (2020-2023).
Conclusions:
- Macrolide resistance in Haemophilus spp. presents considerable challenges for effective treatment.
- Continuous surveillance of resistance trends and investigation into contributing factors are essential.
- Enhanced strategies are needed to combat the rising threat of antimicrobial resistance in these common pathogens.
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