The status of Streptococcus pneumoniae in Iran compared to the world: a systematic review

Abstract

Introduction: Streptococcus pneumoniae is a leading cause of vaccine-preventable deaths worldwide. Sero-epidemiological data on S. pneumoniae is needed in each country to monitor the burden of this important pathogen in each population. The aim of this study was to evaluate the prevalence, antibiotic resistance, prevalent serotypes and virulence factors of S. pneumoniae in Iran, compared to other parts of the world. Methods: A search via Google Scholar, Scopus, PubMed, ISI, Iranmedex, Magiran, SID and ISC was conducted for original articles investigating S. pneumoniae in Iran. The search terms were ‘Streptococcus pneumoniae’, ‘S. pneumoniae’, ‘prevalence’, ‘antibiotic resistance’, ‘antimicrobial resistance’, ‘typing’, ‘serotyping’, ‘virulence factors’, ‘Iran’. Results: The overall prevalence of invasive pneumococcal disease had an increasing trend in Iran. The most common serotypes amongst Iranian population were 1, 19A, 6A/ 6B, 23F, 14,18C, 20, 19, 3, 6, 9 V, 11A and 19F. Resistance to penicillin and co-trimoxazole had significant decreasing trends whilst resistance to erythromycin was increasing although insignificantly. The most prevalent pneumococcal virulence genes were lytA and pspC. Conclusion: Since pneumococcal serotypes differ in invasiveness, virulence, and antibiotic resistance it is important to closely monitor the changes on evolving serotypes, antibiotic resistance and virulence factors of this pathogen to be able to implement suitable prevention and therapeutic strategies.