Evaluation of Resistance to Aminoglycosides among clinical isolates of Acinetobacter baumannii: A Systematic Review and Meta-analysis

In past decades, aminoglycosides have been commonly used to treat gram-negative infections as well as multi-drug resistant tuberculosis strains. However, in recent years, intrinsic, adaptive and acquired resistances have been raised against aminoglycosides which limits the uptake of these antibiotics. Acquired resistance to Acinetobacter baumannii responsible for nosocomial infection against aminoglycosides, has been led to a medical dilemma. In the present study, we aimed to investigate the prevalence rate of A. baumannii resistance to aminoglycosides using a meta-analysis and systematic review. International databases of Scopus, PubMed, Web of Science and Google Scholar, as well as national databases, include SID, Magiran, IranDoc, and IranMedex, were searched carefully and 62 articles published during years 1993 and 2016 were selected. After data extraction, random-effects model was used for analysis. Also, data heterogeneity was assessed using the I2 index and the final statistical analysis was done using STATA and R software. The total sample size of 28,055 extracted from the chosen articles and entered the meta-analysis process. The drug resistance value of A. baumannii isolates to various antibiotics was determined as follows: Amikacin 69% (57% to 81%), Tobramycin61% (52% to 71%), Netilmicin 35% (11% to 59%) and Gentamicin 68% (57% to 80%). The highest and lowest sensitivity of A. baumannii was considered against Netilmicin 57% (32% to 82%) and Gentamicin 26% (12% to 39%), respectively. According to our findings, the drug-resistance rate of A. baumannii clinical isolates to aminoglycosides, especially Amikacin, Tobramycin, and Gentamicin are relatively high. So, Gentamicin and Amikacin are not recommended as first-line treatment of A. baumannii isolates.