Prevalence of bla(CTX-M) Gene among Extended-Spectrum beta-Lactamases Producing Klebsiella pneumoniae Clinical Isolates in Iran: A Meta-Analysis

Abstract

Background: CTX-M-type extended-spectrum beta-lactamases (ESBLs) are the most prevalent ESBLs in bacterial members of Enterobacteriaceae family including Klebsiella pneumoniae. The global spread of CTX-M-producing K. pneumoniae is a major concern in most countries including Iran. The aim of this meta-analysis was to determine the relative frequency (RF) of bla(CTX-M) gene among ESBLs-producing K. pneumoniae clinical isolates in Iran and to report an overall prevalence. Methods: A comprehensive literature search of studies published up to July 2016 was carried out. The keywords "Enterobacteriaceae", "Klebsiella pneumoniae", "ESBLs", "CTX-M" and "Iran" were searched in PubMed, Scopus, EBSCO, Google Scholar, Scirus, SID and IranMedex in both English and Persian. Selected articles were published between July 2010 and July 2016 and all of them were in English. STATA SE version 11.0 was used for statistical analysis. Results: Twenty-four articles/abstracts were included in this analysis. Selected studies were performed in Ahvaz, Arak, Ilam, Kashan, Kerman, Mashhad, Shiraz, Tabriz, Tehran, Zabol, and Zahedan. Our pooled evidence showed that the RF of bla(CTX-M) gene among ESBLs-producing K. pneumoniae clinical isolates varied from 7.7 in Tabriz to 100 in Mashhad, Tehran, and Zahedan, with an overall RF of 56.7. Conclusion: Our meta-analysis revealed that the RF of CTX-M-type ESBLs-producing K. pneumoniae is diverse in different regions of Iran, and the central and eastern regions had higher prevalence rates compared to western regions.