Prevalence of antibiotic resistance of Proteus species in urinary tract infections in Iran: A systematic review and meta-analysis

Urinary tract infections (UTIs) are among the most prevalent bacterial diseases worldwide. Proteus species (spp.) are well-known etiological agents of UTIs. The current study is the first systematic review and meta-analysis reporting the prevalence of antibiotic-resistant and extended-spectrum β-lactamase (ESBL)-producing Proteus spp. in UTIs in Iran. Two independent researchers searched for articles published between January 1, 2000 and October 8, 2021, using related keywords in national and international databases, and then extracted the data. Quality assessment of studies was performed using the Joanna Briggs Institute (JBI) critical assessment checklist for prevalence data and the methodology was assessed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. Data analysis was performed using the Comprehensive Meta-Analysis (CMA) software version 2.2. Under the random-effects model meta-analysis, the pooled frequency of Proteus spp. isolated from UTIs in Iran was 9.3 %. Based on the disk diffusion method, the isolates were mostly resistant against ampicillin (72.1 %), piperacillin (64.3 %), cefoxitin (65.4 %) and trimethoprim/sulfamethoxazole (49.4 %), whereas the highest susceptibility was observed against levofloxacin (100 %) and norfloxacin (92.7 %). On the other hand, the frequency of imipenem-resistant Proteus spp. was 14.5 %. Finally, the prevalence rates of ESBL-producing Proteus spp. as well as multidrug-resistant (MDR) strains were estimated to be 25.8 % and 57.9 %, respectively. Our results suggest that β-lactam/β-lactamase inhibitors, carbapenems, and fluoroquinolones can be the most appropriate treatments for UTIs caused by Proteus spp. in Iran.