Seasonality of antimicrobial resistance rates in respiratory bacteria: A systematic review and meta-analysis

BackgroundAntimicrobial resistance (AMR) rates may display seasonal variation. However, it is not clear whether this seasonality is influenced by the seasonal variation of infectious diseases, geographical region or differences in antibiotic prescription patterns. Therefore, we assessed the seasonality of AMR rates in respiratory bacteria.MethodsSeven electronic databases (Embase.com, Medline Ovid, Cochrane CENTRAL, Web of Science, Core Collection, Biosis Ovid, and Google Scholar), were searched for relevant studies from inception to Jun 25th, 2019. Studies describing resistance rates of Streptococcus pneumoniae and Haemophilus influenzae were included in this review. By using random-effects meta-analysis, pooled odd ratios of seasonal AMR rates were calculated using winter as the reference group. Pooled odd ratios were obtained by antibiotic class and geographical region.ResultsWe included 13 studies, of which 7 were meta-analyzed. Few studies were done in H. influenzae, thus this was not quantitively analyzed. AMR rates of S. pneumoniae to penicillins were lower in other seasons than in winter with pooled OR = 0.71; 95% CI = 0.65–0.77; I2 = 0.0%, and to all antibiotics with pooled OR = 0.68; 95% CI = 0.60–0.76; I2 = 14.4%. Irrespective of geographical region, the seasonality of AMR rates in S. pneumoniae remained the same.ConclusionThe seasonality of AMR rates could result from the seasonality of infectious diseases and its accompanied antibiotic use.

背景 抗菌药物耐药性（Antimicrobial resistance, AMR）检出率可能存在季节波动。然而目前尚不明确这种季节节律是否受传染病季节变化、地理区域差异或抗生素处方模式差异的影响。为此，本研究针对呼吸道病原菌的抗菌耐药率季节节律展开了评估。方法 本研究检索了7个电子数据库，包括Embase.com、Medline Ovid、Cochrane CENTRAL、Web of Science核心合集、Biosis Ovid及Google Scholar，检索时限自建库起至2019年6月25日。纳入本综述的研究需针对肺炎链球菌（Streptococcus pneumoniae）与流感嗜血杆菌（Haemophilus influenzae）的耐药率展开报道。本研究采用随机效应Meta分析，以冬季为参考组，计算季节性抗菌耐药率的合并比值比；并按抗生素类别及地理区域分别获取合并比值比。结果 本研究共纳入13项相关研究，其中7项纳入Meta分析。针对流感嗜血杆菌的相关研究数量较少，因此未对其进行定量分析。相较于冬季，其他季节肺炎链球菌对青霉素类的抗菌耐药率更低，合并比值比（OR）为0.71，95%置信区间（CI）为0.65~0.77，I²=0.0%；而肺炎链球菌对所有受试抗生素的耐药率同样呈现此规律，合并比值比为0.68，95%置信区间为0.60~0.76，I²=14.4%。无论地理区域如何，肺炎链球菌抗菌耐药率的季节节律均保持一致。结论 抗菌药物耐药率的季节节律可能源于传染病的季节波动及其伴随的抗生素使用变化。