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Mechanisms involved in resistance to carbapenems among Acinetobacter baumannii isolates recovered in Brazil: A systematic review and meta-analysis
Mecanismos involucrados en la resistencia a carbapenémicos entre aislamientos de Acinetobacter baumannii recuperados en Brasil: una revisión sistemática y metanálisis
Mecanismos envolvidos na resistência a carbapenêmicos entre isolados de Acinetobacter baumannii recuperados no Brasil: Uma revisão sistemática e metanálise
DOI:
https://doi.org/10.15446/rcciquifa.v51n2.96918Palabras clave:
Acinetobacter baumannii, Brazil, resistance, carbapenem, tigecycline, colistin (en)Acinetobacter baumannii, Brasil, resistencia, carbapenem, tigeciclina, colistina (es)
Acinetobacter baumannii, Brasil, resistência, carbapenem, tigeciclina, colistin (pt)
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Introduction: Infections caused by carbapenem-resistant Acinetobacter baumannii(CRAB) is a health problem due to the limited therapeutic options available. This study was carried out to evaluate the main mechanisms of resistance of carbapenems in CRAB in the last 10 years in Brazil and to describe the susceptibility profile to tigecycline and polymyxins in these isolates. Material and methods: A systematic review was carried out according to Prisma in PUBMED/MEDLINE, Scopus, SciELO, Biblioteca Virtual de Saúde (BVS) and Cochrane Library. Data regarding enzyme resistance to carbapenems were evaluated by meta-analysis according to the random effect. Results: 21 articles were selected according to inclusion and exclu-sion criteria that evaluated 1096 CRAB. Most of the studies were carried out in the southern (33.3 %) and southeast (23.8 %) regions of Brazil (33.3 %) and in 2016 and 2018. According to the meta-analyzes, OXA-type carbapenemase was the main mechanism involved in the low susceptibility to carbapenems in CRAB (98%; 95% CI: 0.91, 0.99; I² = 95%), with blaOXA-23-like(91 %; 95 % CI: 0.76; 0.97; I² = 97 %) or blaOXA-51-like/ ISAba1 (84 %; 95 % CI: 0.15, 0.99; I² = 98 %) genes, followed by metallo-β-lactamases (MBL) (12 %, 95 % CI: 0.09, 0.15, I² = 99 %) and Klebsiella pneumoniae carbapenemase (KPC) (6 %, 95 % CI: 0.04; 0.08; I² = 87 %). Conclu-sion: The included studies showed that susceptibility to colistin (99 %) and tigecy-cline (93 %) remains high and was not affected by carbapenem resistance.
Introducción: las infecciones por Acinetobacter baumannii resistente a carbapené-micos (CRAB) es un problema de salud debido a las limitadas opciones terapéu-ticas disponibles. Este estudio se realizó para evaluar los principales mecanismos de resistencia de los carbapenémicos en CRAB en los últimos 10 años en Brasil y describir el perfil de susceptibilidad a tigeciclina y polimixinas en estos aislados. Material y métodos: se realizó una revisión sistemática de acuerdo con Prisma en PUBMED/MEDLINE, Scopus, SciELO, Biblioteca Virtual de Saúde (BVS) y Cochrane Library. Los datos referentes a resistencia enzimática a los carbapenémicos se evaluaron mediante metaanálisis según el efecto aleatorio. Resultados: se selec-cionaron 21 artículos según criterios de inclusión y exclusión que evaluaron 1.096 CRAB. La mayoría de los estudios se llevaron a cabo en las regiones sur (33,3%) y sureste (23,8 %) de Brasil (33,3 %) y en los años 2016 y 2018. Según los metaanálisis, la carbapenemasa tipo OXA fue el principal mecanismo implicado en la baja suscep-tibilidad a los carbapenémicos en CRAB (98 %; IC 95 %: 0,91; 0,99; I² = 95 %), con blaOXA-23-like (91 %; 95 % CI: 0,76; 0,97; I² = 97 %) o blaOXA-51-like/ ISAba1 (84 %; 95 % CI: 0,15; 0,99 ; I² = 98 %) genes, seguida de metalo-β-lactamasas (MBL ) (12 %; IC95 %: 0,09; 0,15; I² = 99 %) y Klebsiella pneumoniae carbapenemase (KPC) (6 %; IC95 %: 0,04; 0,08; I² = 87 %). Conclusión: los estudios incluidos mostraron que la susceptibilidad a la colistina (99 %) y tigeciclina (93 %) sigue siendo alta y no se ve afectada por la resistencia a los carbapenémicos.
Introdução: as infecções causadas por Acinetobacter baumannii resistente aos carbapenêmicos (CRAB) são um problema de saúde devido às limitadas opções terapêuticas disponíveis. Este estudo foi realizado para avaliar os principais meca-nismos de resistência aos carbapenêmicos em CRAB nos últimos 10 anos no Brasil e descrever o perfil de susceptibilidade à tigeciclina e às polimixinas nesses isolados. Material e métodos: foi conduzida uma revisão sistemática segundo o Prisma nas bases de dados PUBMED/MEDLINE, Scopus, SciELO, Biblioteca Virtual de Saúde (BVS) e Biblioteca Cochrane. Os dados relativos à resistência enzimática aos carbapenêmicos foram avaliados por meta-análises de acordo com o efeito aleatório. Resultados: foram selecionados 21 artigos de acordo com os critérios de inclusão e exclusão que avaliaram 1.096 CRAB. A maioria dos estudos foi realizada nas regiões Sul (33,3 %) e Sudeste (23,8 %) do Brasil e nos anos de 2016 e 2018. De acordo com as metanálises, a carbapenemase do tipo OXA foi o principal mecanismo envolvido na baixa susceptibilidade aos carbapenêmicos em CRAB (98 %; 95% IC: 0.91, 0.99; I² = 95 %), com blaOXA-23-like(91 %; 95 %; IC: 0,76; 0,97; I² = 97 %) ou blaOXA -51-like / ISAba1(84 %; 95 % IC: 0.15, 0.99; I² = 98 %) genes, seguidos por metalo-β-lactamases (MBL) (12 %, 95 % IC: 0,09, 0,15, I² = 99 %) e Klebsiella pneumoniae carbapene-mase (KPC) (6 %, IC 95 %: 0,04; 0,08; I² = 87 %). Conclusão: os estudos incluídos mostraram que a susceptibilidade à colistina (99 %) e tigeciclina (93 %) permanece alta e não foi afetada pela resistência aos carbapenêmicos.
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