Table 1.
Screening of carbapenem-resistant isolates (disk diffusion method)
| Author (year) | Setting | Population | Samples | Microorganism (No.) | MICa | Resistance rate to FQ and AG | Resultsb | Weak points | Strength points |
|---|---|---|---|---|---|---|---|---|---|
|
| |||||||||
| Mobaraki et al (2018)15 | Hospitals in Tabriz | Inpatients and outpatients | Different sites | Pseudomonas aeruginosa (200) | – | TOB 57% GEN 62% CIP 62.% |
• 46.5% of isolates were resistant to IPM | – | • Multicenter study |
| Ghanbari et al (2017)16 | One hospital in Fuldshahr | General inpatients | Urine | Different strains (317) | – | c | • 9.5% of Escherichia coli, 11% of Klebsiella and 25% of Proteus spp. isolates were resistant to IPM | – | • Large sample size |
| Chahoofard et al (2017)17 | One hospital in Bandar Abbas | General inpatients | Urine | Different strains (296) | – | c | • Resistance rate to IPM: Enterobacter spp. 7.1% Citrobacter spp. 0% E. coli 4.9% Klebsiella pneumonia 19.2% P. aeruginosa 21.4% Acinetobacter baumannii 53.2% |
– | • Adequate sample size • Clinical status of patients including duration of hospital stay and comorbidities were evaluated |
| Ansari et al (2017)18 | Two hospitals in Shahrekord | General inpatients | Urine, blood, sputum, wound | A. baumannii (30) | – | NAL 80%, OFX 86 % LVX 66 % | • About 55% of strains were resistant to IPM and DOR • Intermediate resistance rate was 10%–33.3% |
• Small sample size • AGs were not tested |
• Cloning smpA gen |
| Douraghi et al (2016)8 | Four hospitals in Tehran | General inpatients and outpatients | Different sites | A. baumannii (400) | ✓ | – | • 97% were resistant to carbapenems • MIC values of all resistant isolates were above 32 mcg/mL |
– | • Multicenter study • Large sample size |
| Ghasemian et al (2016)9 | Four hospitals in Mazandaran | General ICU patients | Different sites | Acinetobacter spp. (50) | ✓ | CIP 96% AMK 100% | • Resistance to IPM and MEM according to E-test was 100%, and according to disk diffusion was 76% and 96%, respectively • Most common site for sampling was endotracheal tube |
• Small sample size • MIC values did not report |
• Multicenter study |
| Babamahmoodiet al (2015)13 | Three hospitals in Mazandaran | ICU patients | Wound, respiratory secretions, urine, blood | Different strains (114) | – | c | • 14% of P. aeruginosa, 60% of Acinetobacter spp., 33% of E. coli, 16% of Enterobacter and none of K. pneumonia isolates were resistant to IMP | • Small sample size for each strain | • Multicenter study • Demographic features and risk factors for hospital-acquired infection were described |
| Mohajeri et al (2014)14 | Three hospitals in Kermanshah | General inpatients | Blood, urine, sputum | Acinetobacter spp. (104) | – | Not defined | • 48% of isolates were resistant to carbapenems (imipenem and meropenem). 76% of carbapenem-resistant strains were isolated from sputum samples | • Few antibiotics were tested | • Multicenter study |
| Babakhani et al (2014)19 | One hospital in Khorramabad | General inpatients (mostly ICU) | Different sites | Klebsiella spp. (80) | – | GEN 52 % AMK 7.5% CIP 82 % OFX 75% NAL 60% | • 67% and 1% of isolates were resistant to IMP and MEM, respectively | – | |
| Kamalbeik et al (2013)20 | One Poisoning center in Tehran | ICU patients | Different sites | Acinetobacter spp. (40) | – | CIP 97% | • Resistance rates to MEM and IPM were 100% and 62% (27.5% intermediate resistant to IPM) | • Small sample size | – |
| Hashemi et al (2013)21 | Two hospitals in Hamadan | General inpatients and outpatients | Different sites | Enterobacteriaceae spp. (574) | – | c | • Resistance rate to IPM was 32% in inpatients and 4% in outpatients. Resistance rates to IPM in inpatients: Enterobacter 56%, Serratia 54%, Klebsiella 35%, E. coli 32%, and Proteus 11% | – | • Large sample size |
| Shakibaie et al (2012)10 | One hospital in Kashan | ICU patients | Different sites | Acinetobacter spp. (15) | ✓ | CIP 60% GEN 60% AMK 26% | • 73% of isolates were resistant to IPM • MIC range for resistant strains was 128–240 and MIC of IPM for seven isolates was 240 mcg/mL |
• Very small sample size | – |
| Rahbar et al (2010)22 | One hospital in Tehran | General inpatients | Different sites | P. aeruginosa (109) Acinetobacter spp. (88) Stenotrophomonas maltophilia (48) Burkholderia cepacia (12) | – | c | • 1 %, 16%, and 98% of A. baumannii, P. aeruginosa, and S. maltophilia isolates were resistant to IPM, respectively | – | • Demographic and medical data of patients were provided |
| Soroush et al (2010)23 | One pediatric hospital in Tehran | General pediatric patients | Different sites | Acinetobacter spp. (145) | – | In 2007: CIP 79% AMK 58% KAN 71% GEN 65% TOB 61% | • Resistance rate to IPM and MEM was analyzed in years 2006 and 2007 that was about 50% | • Carbapenem resistance was evaluated only in the last 2 years (2006–2007) | • Evaluated carbapenem resistance status in pediatrics • Change in the antibiotics resistance patterns was considered • Site of sampling with highest count of MDR strains in each year considered |
| Yousefi et al (2010)11 | One hospital in Orumie | General inpatients and outpatients | Different sites | P. aeruginosa (160) | ✓ | – | • Approximately 40% of isolates were resistant to IPM, which means MIC for them was 31 mcg/mL • Presence of Class I integron and being in ICU and burn unit led to significantly higher IPM-resistant strains |
• Just IPM was tested | – |
| Rahbar et al (2008)12 | One hospital in Tehran | General inpatients and ICU patients | Not defined | Different strains (202) | ✓ | c | • 40% and 7% of P. aeruginosa and 38% and 27% of A. baumannii isolates were resistant to MEM and IMP, respectively • MIC range value for MEM was 0.5–32 mcg/mL • The majority isolates of P. aeruginosa and A. baumannii had an MIC >32 µg/mL for MEM |
– | |
Notes:
a
MIC values of carbapenems (and not other antimicrobial agents) were determined.
b
Resistant rates were reported according to the disk diffusion test. The unit for all reported MIC values is mcg/mL.
c
For complete information about the resistance to AG and FQ, refer to the original reference.
Abbreviations: AG, aminoglycoside; AMK, amikacin; CDT, combination disk test; CIP, ciprofloxacin; DD, disk diffusion; DDST, double disk synergy test; DOR, doripenem; ERT, ertapenem; ESBL, extended spectrum β-lactamase; FQ, fluoroquinolones; GEN, gentamicin; ICU, intensive care unit; IPM, imipenem; KAN, kanamycin; LVX, levofloxacin; MBL, metallo-β-lactamase; MEM, meropenem; MHT, modified Hodge test; MIC, minimum inhibitory concentration; NAL, nalidixic acid; NOR, norfloxacin; OFX, ofloxacin; TOB, tobramycin.