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Fluoroquinolones-resistant Shigella species in Iranian children: a meta-analysis

World Journal of Pediatrics volume 15, pages 441–453 (2019)Cite this article

Abstract

Background

Shigella is one of the most common causes of childhood dysentery along with high rate of morbidity and mortality in both developing and developed countries. According to the World Health Organization (WHO) reports, the prevalence of fluoroquinolones-resistant Shigella species is increasing worldwide which can cause treatment failure of Shigella infections. Since there has not been any comprehensive information on drug-resistant Shigella species in Iran, we conducted the following meta-analysis to raise awareness.

Methods

We conducted a literature search on antibiotic resistance of Shigella species to collect published studies in Iran using national and international databases. Literature search was performed by up to Jan 30, 2019 and eligible studies were included in the meta-analysis by predefined criteria.

Results

Antimicrobial susceptibility testing using disk diffusion technique was the only used method in all included studies. Antibiotic resistance characteristics of Shigella species against WHO recommended therapeutic regimens were as follows: S. dysenteriae 7%, S. flexneri 3.8%, S. boydii 6.9% and S. sonnei 2.6% to ciprofloxacin, S. dysenteriae 27.9%, S. flexneri 19.3%, S. boydii 15.7% and S. sonnei 9.5% to ceftriaxone and also S. dysenteriae 91.7%, S. flexneri 20.7%, S. boydii 46.7% and S. sonnei 32.3% to azithromycin. Resistance to pivmecillinam has not been investigated in Iran.

Conclusions

Our findings revealed that ciprofloxacin can still be used as the first-line antibiotic for Shigella infections in Iranian children. However, it seems that second-line antibiotics i.e., ceftriaxone and azithromycin are not good choices for treatment and thus not recommended.

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Funding

No external funding was secured to conduct this study.

Author information

Affiliations

  1. Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Daneshgah Street, Ardabil, 5618985991, Iran

    Farzad Khademi

  2. Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran

    Amirhossein Sahebkar

  3. Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

    Amirhossein Sahebkar

  4. School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran

    Amirhossein Sahebkar

Authors
  1. Farzad Khademi
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  2. Amirhossein Sahebkar
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Contributions

FK presented idea, performed systematic search, data collection and meta-analysis; AS contributed to perform systematic search, to the analysis of the results and to the writing of the manuscript. All authors approved the final version of the manuscript.

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Correspondence to Farzad Khademi.

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Khademi, F., Sahebkar, A. Fluoroquinolones-resistant Shigella species in Iranian children: a meta-analysis. World J Pediatr 15, 441–453 (2019). https://doi.org/10.1007/s12519-019-00263-1

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  • DOI: https://doi.org/10.1007/s12519-019-00263-1

Keywords

  • Antibiotic resistance
  • Fluoroquinolone
  • Iran
  • Shigella