Prevalence of integron classes in Gram-negative clinical isolated bacteria in Iran: a systematic review and meta-analysis

Objective(s): Integrons, as a potential element in the distribution and maintenance of drug resistance, have thoroughly been established. It is known that the high prevalence of integrons in multidrug-resistant (MDR) clinical isolates has become a serious public health concern. The objective of the present study was to determine the frequency of different classes of integrons in clinical isolates in Iran. Materials and Methods: Electronic global databases were systematically searched. The raw data for integrons among bacterial isolates were collected and their prevalence was analyzed using Comprehensive Meta-Analysis V2.0 (Biostat, Englewood, NJ, USA) software. Results: In a comprehensive literature review, 29 eligible studies were determined with their meta-analyses indicating the prevalence of integron class 1 to be 41% (95% CI 36.3-46.1) and integron class 2 as 17.7% (95% CI 13-23.3) in Gram-negative bacteria. The highest prevalence of integron class 1 was reported in Acinetobacter spp (58%) while the highest prevalence of integron class 2 was reported in Shigella isolates (83.7%). The frequencies of class 1 integron in MDR (79%) and non-MDR isolates (41%) were higher than those for class 2 integron in MDR (13.4%) and non-MDR isolates (17.7%). Conclusion: The current systematic review demonstrated the significant presence of integrons among clinical isolates. Our analysis showed that measures such as estimates of the prevalence of this transposable element and diligence in continued surveillance might be necessary to prevent its spread.