Background
Methods
Literature search
Inclusion criteria:
-
Studies having at least 30 bacteria, isolated from human samples in Pakistan (according to the Central Limit Theorem, the minimum sample size is 30),
-
Articles published onward 2009 till March 2020 in the English language,
-
Studied AMR of any WHO enlisted priority bacterial pathogen [12] from Pakistan.
-
Studies done in laboratory site with confident cutoff value for antimicrobial sensitivity testing.
-
Mentioned the total sample size and the resistance/susceptible percentage of bacteria.
Exclusion criteria
Data mining
Data analysis
Results
Literatures features
Pathogen | N studies | UTI N(%) | EF N (%) | WI N (%) | RTI N (%) | BSI N (%) | DTI N (%) | MI N(%) | NM N (%) |
---|---|---|---|---|---|---|---|---|---|
Acinetobacter spp | 15 | – | – | 1(6.67%) | 2(13.3%) | – | – | 3(20%) | 9(60%) |
E. coli | 28 | 13(46.4%) | – | 3(10.71%) | – | 2(7.14%) | 2*(7.1%) | – | 8(28.5%) |
Enterococcus spp | 4 | 2(50%) | – | – | – | – | – | – | 2(50%) |
H. pylori | 3 | – | – | – | – | – | 3(100%) | – | – |
Haemophilus spp | 1 | – | – | – | 1(100%) | – | – | – | – |
Klebsiella spp | 13 | 3(23.1%) | – | 2(15.3%) | – | 1(7.69%) | – | 2(15.38%) | 5(38.4%) |
N. gonorrhea. | 2 | 1(50%) | – | – | – | – | – | – | 1(50%) |
Proteus spp | 2 | – | – | 1(50%) | – | 1(50%) | – | – | – |
Pseudomonas spp | 13 | 1(7.7%) | – | 2(15.3)% | 1(7.69%) | 1(7.69%) | – | 2(15.38%) | 6(46.1%) |
S. aureus | 20 | – | – | 5(25%) | – | 1(5%) | – | 4(20%) | 10(50%) |
Salmonella spp | 10 | – | 10(100%) | – | – | – | – | – | – |
Shigella spp | 4 | – | – | – | – | – | 2(50%) | 1(25%) | 1(25%) |
Streptococcus spp | 2 | – | – | – | 2(100%) | – | – | – | – |
Source of infection | No of studies | References |
---|---|---|
Hospital-acquired | 7 (7.527%) | |
Community-acquired | 7 (7.527%) | |
Both | 2 (2.150%) | |
Not mentioned | 77(82.796%) | NA |
Characteristics | No of studies | References |
---|---|---|
Patient type | ||
Inpatient | 31 (40.259%) | |
Outpatient | 5 (6.494%) | |
Both | 18 (23.377%) | |
Not mentioned | 23 (29.87%) | |
Gender | ||
Female | 2 (2.597%) | |
Both male and female | 40 (51.948%) | |
Not Mentioned | 35 (45.455%) | |
Age group | ||
Adults | 25 (32.467%) | |
Pediatric+ adult | 17 (22.078%) | |
Pediatric | 7 (9.091%) | |
Pediatric+ neonates | 2 (2.597%) | |
Neonates | 3 (3.896%) | |
Not mentioned | 23 (29.871%) |
Characteristics | No of studies | References |
---|---|---|
Patient type | ||
Inpatient | 10 (34.483%) | |
Outpatient | 1 (3.449%) | [101] |
Both | 6 (20.689%) | |
Not mentioned | 12 (41.379%) | |
Gender | ||
Both male and female | 14 (48.276%) | |
Not Mentioned | 15 (51.724%) | |
Age group | ||
Adults | 12 (41.379%) | |
Pediatric+ adult | 2 (6.897%) | |
Pediatric | 1 (3.448%) | [75] |
Neonates | 2 (6.897%) | |
Not mentioned | 12 (41.379%) |
Characteristics | No of studies | References |
---|---|---|
Bacterial Identification method | ||
Morphology/Biochemical testing | 30 (38.961%) | |
API | 24 (31.168%) | |
VITEK | 4 (5.195%) | |
MALDI-TOF | 1 (1.299%) | [59] |
PCR | 8 (10.390%) | |
Not mentioned | 10 (12.987%) | |
Phenotypic detection method∆ | ||
DDM* | 63 (81.818%) | |
Dilution | 15 (19.48%) | |
E Testρ | 7 (9.091%) | |
Vitek2 | 4 (5.195%) | |
Not mentioned | 2 (2.597%) | |
Break point references guidelines∆ | ||
CLSI° | 59 (76.623%) | |
EUCASTγ | 2 (2.597%) | |
Not mentioned | 17 (22.078%) |
Characteristics | No of studies | References |
---|---|---|
Bacterial Identification method | ||
Morphology/Biochemical testing | 22 (75.863%) | |
API | 2 (6.896%) | |
PCR | 2 (6.896%) | |
Not mentioned | 3 (10.345%) | |
Phenotypic detection method∆ | ||
DDM* | 26 (89.655%) | |
Dilution | 4 (13.793%) | |
E Testρ | 5 (17.241%) | |
Vitek2 | 1 (3.448%) | [89] |
Break point references guidelines∆ | ||
CLSI° | 24 (82.759%) | |
BSAC5 | 1 (3.448%) | [75] |
Not mentioned | 5 (17.241%) |
Test | No of studies | References |
---|---|---|
Gram staining | 33 | |
Oxidase test | 12 | |
Catalase test | 18 | |
Motility test | 10 | |
Coagulase test | 9 | |
Bile esculin test | 1 | [76] |
Triple Sugar Iron (TSI) | 6 | |
Citrate test | 7 | |
Urease test | 4 | |
Hydrogen Sulfide test | 1 | [38] |
Methyl red | 2 | |
Indole | 8 | |
Voges–Proskauer test | 2 | |
Pyocyanin Production | 1 | [95] |
Lysine test | 1 | [70] |
Slide agglutination test | 1 | [73] |
Deoxyribonuclease (DNase) | 4 | |
Mannitol fermentation | 2 | |
Sugar fermentation test | 2 |
Antibiotic-resistance/susceptible pattern
MDR | |||
---|---|---|---|
Bacteria | % OR M Prevalence(%), 95%C1* | No of studies | References |
No of isolates | |||
Acinetobacter spp | 33.5% (7–87) | 3 | |
335 | |||
Salmonella spp | 65.4% (58.7–72) | 2 | |
234 | |||
E. coli | 63.3% | 1 | [34] |
150 | |||
Shigella spp | 2.3% | 1 | [73] |
1573 | |||
Pseudomonas spp | 55% | 1 | [57] |
176 | |||
XDR | |||
Acinetobacter spp | 94.2% | 1 | [18] |
137 | |||
Salmonella spp | 100% | 1 | [64] |
33 |
Antibiotics resistance genes
isolates | genes | %/M prevalence (95%CI)** | No of isolates | No of studies | Reference |
---|---|---|---|---|---|
Acinetobacter spp | blaOXA* | 62.00%(24–100) | 364 | 2 | |
blaOXA-23 | 87.00% (7.96–94) | 472 | 5 | ||
blaPER* | 37.17% | 47 | 1 | [14] | |
blaNDM-1 | 1.11% | 90 | 1 | [17] | |
blaTEM* | 46% | 317 | 1 | [19] | |
blaSHV* | 34% | 317 | 1 | [19] | |
blaIMP1 | 12% | 317 | 1 | [19] | |
blaVIM* | 7% | 137 | 1 | [19] | |
aphA1 | 10% | 169 | 1 | [23] | |
aphA6 | 91.3% | 169 | 1 | [23] | |
aacC1 | 8.1% | 169 | 1 | [23] | |
aadB | 75% | 169 | 1 | [23] | |
sul1 | 10.7% | 169 | 1 | [23] | |
sul2 | 72.5% | 169 | 1 | [23] | |
mcr-1 | 1.61% | 62 | 1 | [10] | |
Enterococcus sp | VanA | 45.53% (1.06–90) | 124 | 2 | |
E. coli | blaTEM* | 48.61% (28–72.60) | 422 | 3 | |
blaTEM-1 | 17.2% | 29 | 1 | [24] | |
blaCTXM* | 54.55% (9.09–100) | 131 | 2 | ||
blaCTXM-15 | 24.80% (22–27.60) | 106 | 2 | ||
blaCTXM-1 | 82.4% | 638 | 1 | [33] | |
blaCTXM-111 | 9.2% | 638 | 1 | [33] | |
blaSHV* | 18.10% (15.20–61) | 393 | 2 | ||
blaOXA* | 34.60% (17.20–52) | 350 | 2 | ||
blaNDM-1 | 28.80% (9–41) | 155 | 3 | ||
blaKPC-2 | 31.67% (30–33.33) | 74 | 2 | ||
tetB | 62% | 29 | 1 | [24] | |
tetA | 17% | 27 | 1 | [24] | |
aadA1 | 13.8% | 29 | 1 | [24] | |
catA | 68.9% | 29 | 1 | [24] | |
catP | 68.9% | 29 | 1 | [24] | |
Blt | 58.6% | 29 | 1 | [24] | |
aac(6′)-Ib-cr | 40% | 268 | 1 | [30] | |
qepA | 2.6% | 268 | 1 | [30] | |
Mutation in gyrA | 59.97% (37.1–82.80) | 254 | 2 | ||
Mutation in parC | 68.57% | 225 | 1 | [38] | |
H. pylori | Mutation in 23S rRNA | 23.9% | 46 | 1 | [44] |
Klebsiella spp | blaNDM-1 | 32.75% (4–61.50) | 140 | 2 | |
blaIMP* | 3% | 103 | 1 | [50] | |
Pseudomonas spp | blaNDM-1 | 16.9% | 39 | 1 | [59] |
mcr-1 | 1.19% | 84 | 1 | [10] | |
Salmonella spp | blaTEM-1 | 43.75% | 80 | 1 | [68] |
strA-strB | 26.255% | 80 | 1 | [68] | |
Sul1 | 30% | 80 | 1 | [68] | |
Sul2 | 67.5% | 80 | 1 | [68] | |
Cat* | 26.5% | 80 | 1 | [68] | |
dfrA7 | 37.5% | 80 | 1 | [68] | |
tetB | 35% | 80 | 1 | [68] | |
Shigella spp | blaTEM* | 78.94% | 95 | 1 | [71] |
blaCTXM* | 12.63% | 95 | 1 | [71] | |
Mutation in gyrA | 20% | 95 | 1 | [71] | |
Mutation in gyrB | 21.05% | 95 | 1 | [71] | |
qnrS | 21.05% | 95 | 1 | [71] | |
aadA1 | 67.36% | 95 | 1 | [71] | |
strAB | 42.1% | 95 | 1 | [71] | |
tetA | 12.63% | 95 | 1 | [71] | |
tetB | 53.68% | 95 | 1 | [71] | |
catA | 33.68% | 95 | 1 | [71] | |
catP | 25.26% | 95 | 1 | [71] | |
S. aureus | Cfr | 78% | 150 | 1 | [80] |
VanA | 74% | 150 | 1 | [80] |