Global trends and molecular epidemiology of Azithromycin-resistant Salmonella: A systematic review and meta-analysis.
The pooled prevalence of azithromycin resistance in Salmonella is 9.12%, with significant proportions being multidrug-resistant and extensively drug-resistant.
Where it sits
this study against the rest of the ll-37 corpusSummary and findings
This systematic review and meta-analysis evaluated the prevalence of azithromycin resistance in Salmonella isolates globally, analyzing data from 15,514 isolates. The pooled prevalence of azithromycin resistance was found to be 9.12%. Among azithromycin-resistant isolates, 31.10% were multidrug-resistant and 19.30% were extensively drug-resistant.
Abstract
Introduction Salmonella infections pose a significant public health challenge, affecting both social and economic dimensions across various countries. Different animal species serve as reservoirs for Salmonella and contribute to drug resistance in human isolates. The improper use of antimicrobials in livestock, companion animals, and humans has led to the rise of multidrug-resistant (MDR), extensively drug-resistant (XDR), and azithromycin-resistant Salmonella serovars globally. This systematic review and meta-analysis aim to evaluate heterogeneity, estimate pooled proportions, and outline the molecular epidemiology of these resistant Salmonella serovars worldwide. Methods We analyzed data from 15,514 Salmonella isolates, focusing on their genetic and phenotypic characteristics. Our analysis included meta-analyses and frequency analyses based on the studies' geographical locations, the types of isolates, and potential biases. We employed a random-effects model, specifically the DerSimonian-Laird method, to evaluate heterogeneity and estimate pooled proportions. The result is presented as a proportion and confidence interval after the inverse of the Freeman-Tukey transformation; otherwise, all the calculations were made using the Freeman-Tukey double arcsine transformation. Results The pooled prevalence of azithromycin resistance among Salmonella isolates was 9.12% (95% CI: 6.53-12.07). Among azithromycin-resistant isolates, multidrug-resistant (MDR) and extensively drug-resistant (XDR) serovars accounted for 31.10% (95% CI: 18.82-44.86) and 19.30% (95% CI: 6.90-35.75), respectively. Resistance mechanisms involved multiple genetic factors, including efflux pumps (mefA, acrB gene mutation), enzymatic phosphorylation (mphA), and class 1 integrons gene cassettes. Notably, resistance rates varied by region and serovar, with high prevalence in Southern Asia and Eastern Europe. Conclusion Azithromycin resistance in Salmonella is a growing global health concern, complicated by the presence of MDR and XDR strains and diverse resistance mechanisms. Urgent, coordinated efforts encompassing enhanced surveillance, antimicrobial stewardship, and research are critical to controlling resistance and preserving azithromycin's efficacy in treating invasive salmonellosis through a One Health approach. Additionally, addressing antimicrobial use in the agriculture and veterinary sectors is critical to safeguarding public health. Registration We conducted a systematic review and meta-analysis after registering the protocol with PROSPERO (CRD420251047985), following the MOOSE (Meta-Analysis of Observational Studies in Epidemiology) guidelines.
Background
This paper addresses the public health challenge posed by Salmonella infections, particularly focusing on the rise of azithromycin-resistant strains. Prior knowledge indicates that improper antimicrobial use contributes to drug resistance in various species, including Salmonella. Understanding the molecular epidemiology and prevalence of these resistant strains is crucial for developing effective public health strategies.
Methods
The study utilized a systematic review and meta-analysis design, analyzing data from 15,514 Salmonella isolates. It employed a random-effects model, specifically the DerSimonian-Laird method, to evaluate heterogeneity and estimate pooled proportions. The analysis included geographical variations and types of isolates as primary outcome measures.
Results
The primary endpoint revealed a pooled prevalence of azithromycin resistance among Salmonella isolates at 9.12% (95% CI: 6.53-12.07). Among the azithromycin-resistant isolates, multidrug-resistant serovars accounted for 31.10% (95% CI: 18.82-44.86) and extensively drug-resistant serovars for 19.30% (95% CI: 6.90-35.75).
Interpretation
The findings indicate a significant prevalence of azithromycin resistance in Salmonella, which aligns with previous literature on rising antimicrobial resistance. While the statistical significance is clear, the clinical implications depend on the context of treatment and regional resistance patterns. Limitations include potential biases in the included studies and the lack of detailed geographical data, which may affect the generalizability of the results.
Key findings
- 9.12% azithromycin resistance among Salmonella isolates (95% CI: 6.53-12.07)
- 31.10% of azithromycin-resistant isolates were multidrug-resistant (95% CI: 18.82-44.86)
- 19.30% of azithromycin-resistant isolates were extensively drug-resistant (95% CI: 6.90-35.75)
Limitations
- Not reported in abstract.
- Potential biases in included studies.
- Lack of detailed geographical data on isolates.