Prevalence of vancomycin resistance among isolates of enterococci in Iran: a systematic review and meta-analysis

Abbas Moghimbeigi,1,2 Meisam Moghimbeygi,3 Majid Dousti,4 Faezeh Kiani,5 Fatemeh Sayehmiri,6 Nourkhoda Sadeghifard,7 Ali Nazari8 1Modeling of Noncomunicable Disease Research Center, Department of Biostatistics, Faculty of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran; 2Department of Biostatistics, Faculty of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran; 3Department of Statistics, Faculty of Mathematical Sciences, Tarbiat Modares University, Tehran, Iran; 4Department of Parasitology and mycology, Faculty of Medicine, Shiraz University of Medical Sciences, Fars, Iran; 5Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran; 6Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 7Microbiology Research Center, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran; 8School of Medicine, Ilam University of Medical Sciences, Ilam, Iran Introduction: Enterococcus is responsible for 10% of hospital-acquired infections. The purpose of this review was to evaluate the prevalence of vancomycin-resistant Enterococcus (VRE) isolates in Iran using a meta-analysis method.Materials and methods: Iranian databases, including Magiran and IranDoc, and international databases, including PubMed and MedLib, were examined carefully, and a total of 20 articles published between 2000 and 2011 were extracted. The data were subjected to meta-analysis and random-effects models. In addition, heterogeneous studies were assessed using the I2 index. Finally, the data were analyzed using R and STATA software.Results: The results showed that the strain of Enterococcus faecalis had been more common than Enterococcus faecium in clinical infection (69%  vs 28%). However, resistance to vancomycin was higher among strains of E. faecium compared with strains of E. faecalis (33%  vs 3%). The complete resistance, intermediate resistance, and sensitivity to vancomycin among Enterococcus isolates were 14% (95% CI: 11, 18), 14% (95% CI: 5, 23), and 74% (95% CI: 65, 83), respectively. The resistance patterns, depending on the sample type, did not show a significant difference. In addition, the resistance of isolated strains to vancomycin in outpatients was significantly higher than that in inpatients (16%  vs 1%). Moreover, 80%–86% of resistant strains were genotype van A and 14%–20% of resistant strains were genotype van B.Conclusion: The findings of the present review show that there is a high frequency of resistant Enterococcus in Iran. Therefore, consideration of the prevalence and frequency of subjected resistant strains can be helpful for decision makers to implement proper health policies in this direction. Keywords: clinical infections, gram-positive bacteria, enterococci, antibiotic resistance, glycopeptide antibiotic