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Rate of polymyxin resistance among Acinetobacter baumannii recovered from hospitalized patients: a systematic review and meta-analysis

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Abstract

We conducted a systematic review and meta-analysis to determine the rate of polymyxin resistance among Acinetobacter baumannii isolates causing infection in hospitalized patients around the world during the period of 2010–2019. The systematic review was performed on September 1, 2019, using PubMed/MEDLINE, Scopus, and Web of Science; studies published after January 1, 2010, were selected. The data were summarized in tables, critically analyzed, and treated statistically using the RStudio® Software with Meta package and Metaprop Command. After applying exclusion factors, 41 relevant studies were selected from 969 articles identified on literature search. The overall rate of polymyxin-resistant A. baumannii (PRAB) related to hospitalized patients was estimated to be 13% (95% CI, 0.06–0.27), where a higher rate was observed in America (29%; 95% CI, 0.12–0.55), followed by Europe (13%; 95% CI, 0.02–0.52), and Asia (10%; 95% CI, 0.02–0.32). The extensive use of polymyxins on veterinary to control bacterial infection and growth promotion, as well as the resurgence in prescription and use of polymyxins in the clinics against carbapenem-resistant gram-negative bacteria, may have contributed to the increased incidence of PRAB. The findings of this meta-analysis revealed that the rate of PRAB recovered from hospitalized patients is distinctively high. Thus, action needs to be taken to develop strategies to combat the clinical incidence of PRAB-induced hospital infections.

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Acknowledgments

We thank UFSJ/PPGCF, UFMG/Pharmacy school-PPGCF, and UFMG/Department of Chemistry-PPGITB for the availability of bibliographic support. W.G.L. is grateful to Coordenação de Aperfeiçoamento de Pessoal do Nível Superior (CAPES) for a Ph.D. fellowship.

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  1. William Gustavo Lima and Júlio César Moreira de Brito contributed equally to this work.

Authors and Affiliations

  1. Laboratório de Radioisótopos, Departamento de Análises Clinicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil

    William Gustavo Lima, Bárbara Gatti Cardoso, Valbert Nascimento Cardoso & Simone Odília Antunes Fernandes

  2. Laboratório de Diagnóstico Laboratorial e Microbiologia Clínica, Campus Centro-Oeste/Dona Lindu, Universidade Federal de São João del-Rei, Rua Sebastião Gonçalves Coelho, 400, Divinópolis, MG, 35501-293, Brazil

    William Gustavo Lima & Magna Cristina de Paiva

  3. Fundação Ezequiel Dias (FUNED), Belo Horizonte, MG, Brazil

    Júlio César Moreira Brito

  4. Programa de Pós-Graduação em Inovação Tecnológica e Biofarmacêutica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil

    Júlio César Moreira Brito & Maria Elena de Lima

  5. Instituto de Ensino e Pesquisa, Santa Casa-Belo Horizonte, Belo Horizonte, Brazil

    Maria Elena de Lima

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Lima, W.G., Brito, J.C.M., Cardoso, B.G. et al. Rate of polymyxin resistance among Acinetobacter baumannii recovered from hospitalized patients: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 39, 1427–1438 (2020). https://doi.org/10.1007/s10096-020-03876-x

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