Abstract
Shigellosis causes diarrheal disease in humans in both developed and developing countries, and multi-drug resistance in Shigella is an emerging problem. Understanding changing resistance patterns is important in determining appropriate antibiotic treatments. This meta-analysis systematically evaluated aminoglycoside resistance in Shigella. A systematic review was constructed based on MEDLINE and EMBASE databases. Random-effect models or fixed-effect models were used based on P value considering the possibility of heterogeneity between studies for meta-analysis. Data manipulation and statistical analyses were performed using software STATA 11.0. By means of meta-analysis, we found a lower resistance to three kinds of aminoglycosides in the Europe-America areas during the 12 year study period than that of the Asia-Africa areas. Kanamycin resistance was observed to be the most common drug resistance among Shigella isolates with a prevalence of 6.88% (95%CI: 6.36%-7.43%). Comparison of data from Europe-America and Asia-Africa areas revealed that Shigella flexneri resistance was greater than the resistance calculated for Shigella sonnei. Importantly, Shigella sonnei has played a significant role in aminoglycoside-resistance in recent years. Similarly, data showed that resistance to these drugs in children was higher than the corresponding data of adults. In conclusion, aminoglycoside-resistant Shigella is not an unusual phenomenon worldwide. Distribution in Shigella resistance differs sharply based on geographic areas, periods of time and subtypes. The results from the present study highlight the need for continuous surveillance of resistance and control of antibiotic usage.
Highlights
Acute gastroenteritis and diarrheal diseases continue to be a health problem worldwide, especially in developing countries
The present study aimed to identify the worldwide prevalence and distribution of aminoglycosideresistant Shigella using meta-analysis based on data gathered from a systematic review of articles reported between January 1999 and July 2012
Regardless of its origins and mechanisms, the widespread resistance that we found among S. flexneri and S. sonnei suggests that infections due to drug-resistant Shigella are endemic around the world
Summary
Acute gastroenteritis and diarrheal diseases continue to be a health problem worldwide, especially in developing countries. They account for approximately 2.5 million deaths per year in children < 5 years of age[1,2]. The most common bacterial pathogens causing these diseases are: Salmonella spp, Shigella (S.) spp, Campylobacter spp, Escherichia coli O157:H7, Listeria monocytogenes, Vibrio cholerae, and Yersinia enterocolitica[3,4]. Infection by Shigella species is an important global public health problem[6]. Shigellosis is recognized by the World Health Organization (WHO) as major global public health concern[7,8]
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