Evaluation of Frequency, Drug Resistance and Serotyping of Streptococcus Pneumoniae in Iran: A Systematic Review

Abstract

BACKGROUND AND OBJECTIVE: Streptococcus pneumoniae is one of the main etiologies of meningitis, pneumonia, sinusitis, and middle ear infection associated with significant morbidity and mortality. This report aims to review and report the serotype distribution and antimicrobial resistance patterns and determine the frequency of S. pneumoniae in Iran. METHODS: A systematic literature review of the literature published from January 1990 to August 2020 was performed to identify articles that have been published in Google Scholar, Scopus, PubMed, SID, IranMedex, and Magiran databases that describe the serotype distribution, antimicrobial resistance patterns and frequency of S. pneumoniae in Iran. The search terms were "Streptococcus pneumoniae, Antibiotic resistance, Serotyping, Systematic review, and Iran". The exclusion criteria were review articles or case reports, reports only emphasizing on serogroups rather than serotypes, and having isolates fewer than 10. FINDINGS: Of 56 reports, 33 publications that met our inclusion criteria were selected for data extraction and analysis. The frequency of S. pneumoniae in patients and carriers was estimated at 1.5% and 20%, respectively. Highest levels of resistance were against co-trimoxazole followed by penicillin, and erythromycin. The most common serotypes were 23F followed by 19F, 6A/B, 19A, and 18C. CONCLUSION: Based on the results of this study, the inappropriate use of antibiotics and the subsequent spread of resistant pneumococcal isolates in our country is worrisome.