Recent Macrolide Resistance Pattern of Mycoplasma Pneumonia in the World: A Systematic Review and Meta-Analysis

Ilad Alavi  Darazam; Mohammad Mahdi  Rabiei; Farid Javandoust  Gharehbagh; Firouze  Hatami; Shahrzad  Shahrokhi; Ali  Akhgarzad; Hadi Allahverdi  Nazhand; Hadi  Ebadi; Amir Hossein  Zeininasab; Neda  Kazeminia; Legha  Lotfollahi; Sajad  Shojaee

doi:10.18502/ijph.v54i3.18246

Ilad Alavi Darazam Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Mohammad Mahdi Rabiei Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Farid Javandoust Gharehbagh Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Firouze Hatami Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Shahrzad Shahrokhi Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Ali Akhgarzad Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Hadi Allahverdi Nazhand Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Hadi Ebadi Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Amir Hossein Zeininasab Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Neda Kazeminia Food and Drug Administration, Iran Ministry of Health and Medical Education, Tehran, Iran
Legha Lotfollahi Department of Nephrology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Sajad Shojaee Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/ijph.v54i3.18246

Keywords: Macrolide-resistant; Mycoplasma pneumoniae; Meta-analysis; Antimicrobial resistance; Drug resistance

Abstract

Background: We aimed to systematically review and analyze the prevalence and pattern of resistance in Mycoplasma pneumoniae.

Methods: We searched authentic scientific sources and databases, and reference lists of relevant articles from Jan 1, 2017, to Jun 1, 2023.

Results: Most of the included studies were conducted in Asia (11470 patients). The overall pooled prevalence was 53% (41%-65%), I2=99.69%; P <0.001. While subgroups analyses revealed that the pooled prevalence for America (3 studies), Asia (29 studies), and Europe (3 studies) was 9% (5%-12%), 62% (52%-73%), and 6% (1%-12%), respectively. Twenty-one eligible studies for determining of A2063G and 16 for A2064G were analyzed. Global pooled prevalence was 67% (58%-76%), I2=99.65%; P<0.001, and 3% (2%-4%), I2=87.44%; P<0.001 for A2063G and A2064G, respectively. Pooled prevalence of A2063G for America, Asia and Europe was 10% (5%-16%), 77% (71%-83%) and 5% (2%-9%), respectively.

Conclusion: While the prevalence of macrolide-resistant M. pneumonia is quite low in America, it is a great dilemma in East Asia and the low prevalence in most countries could be underestimated. This study revealed an increasing trend in macrolide resistance. Indiscriminate and improper use of macrolides may be a warning in this regard.