A Systematic Review and Meta-analysis on the Epidemiology of Antibiotic-resistant Yersinia Species in Food and Clinical Specimens in Iran

Objective: The aim of the present study was to investigate the antimicrobial susceptibility profiles of Yersinia species, especially Y. enterocolitica from non-clinical and clinical isolates in Iran. Materials and Methods: We systematically searched PubMed, Scopus, Google Scholar, and the Scientific Information Database (SID) using “antibiotic resistance”, “Yersinia”, and “Iran” as major keywords until June 10, 2019. According to the predefined article selection criteria, published studies addressing the epidemiology of antibiotic-resistant Yersinia species in Iran were included in the meta-analysis. Data were extracted and exported to the Comprehensive Meta-Analysis Software to evaluate antibiotic resistance rates, heterogeneity of studies and publication bias. Results: Twelve studies reported antimicrobial susceptibility testing using disk diffusion method. The pooled prevalence of antibiotic-resistant Yersinia species in food and clinical specimens in Iran was as follows: 22.4% to amoxicillin, 41.9% to ampicillin, 6% to gentamicin, 17% to trimethoprim/ sulfamethoxazole, 19% to tetracycline, 10.3% to ciprofloxacin, 10.5% to streptomycin, 3.8% to chloramphenicol, 79.3% to cephalothin, 18.4% to nalidixic acid, 6.6% to cefotaxime, and 12.2% to trimethoprim. Conclusion: This study revealed a high prevalence of resistant Y. enterocolitica strains isolated from food and clinical specimens in Iran to β-lactams, while the resistance rates to aminoglycosides, fluoroquinolone and chloramphenicol were low. Our findings recommended the necessity of a continuous surveillance of the resistance patterns and prudent use of trimethoprim/ sulfamethoxazole, tetracycline, and nalidixic acid to prevent the development of antibioticresistant Y. enterocolitica strains in Iran.