Changes in Antibiotic Resistance of Pseudomonas aeruginosa Isolates Over the Past 11 Years in Turkey: A Meta-Analysis

Abstract

The increased antibiotic resistance and diversity of resistance mechanisms in clinical isolates of Pseudomonas aeruginosa lead to serious problems in treatment. Bacterial resistance against antibiotics can be influenced by patient characteristics, antibiotic usage policy depending on the country, region, hospital, clinics and even may vary during treatment. In this meta-analysis study, we aimed to evaluate the trends in P.aeruginosa antibiotic resistance over the past 11 years. The study was planned and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the literature search method, criteria for inclusion and exclusion, evaluation of publications, data collection, and statistical analysis were performed. To identify relevant publications, two national databases (ULAKBIM and TURK MEDLINE) and one international database (Pub Med) were searched. Published manuscripts were evaluated for exclusion criteria, after the study data were collected, and statistical analyses were performed. The data obtained from the literature were assessed under a common unit. The calculations made in the 95% confidence interval value of p <= 0.05 was considered statistically significant. As a result of exclusion criteria, meta-analysis was performed for 48 studies published between 2003 and 2013. For the evaluation of the changes in antibiotic resistance of P.aeruginosa isolates over time, studies were divided into three groups according to the year of publication. The number of publications was relatively consistent over the course of the study period with 17 studies published in 2003-2006; 14 in 2007-2009, and 17 in 2010-2013. There were significant changes in antibiotic resistance results within years however, none of these differences were statistically significant (p> 0.05). Carbapenem resistance, especially imipenem resistance, increased between 2007 and 2009, however, the changes were not statistically significant for either imipenem or meropenem (p= 0.254, p= 0.499, respectively). Through the 11-year period, the resistance rates for imipenem and meropenem were 29.4% and 32.1%, respectively. In the last 4 years of the study period, notable decrease were reported in antibiotic groups except for cefepime from cephalosporins and monobactam; the resistance rates for cephalosporins remained unchanged during this time period. The reported resistance rates for cefepime and ceftazidime were 41.4% and 43.9%, respectively. Similar decreases in resistance to aminoglycoside antibiotics, including amikacin, gentamicin, netilmicin, and tobramycin, were also seen, however, these changes were not statistically significant (p> 0.05). The current data suggested that antibiotic resistance in P.aeruginosa has a tendency to decrease in our country. Though being at the bottom of the ladder, it can be expressed that rational and restricted use of antibiotics policy, contributed to the strength of the decrease; however for the decline of resistance to a reasonable level, new and sustainable policy is necessary to be implemented.