Sensitivity of <>iStreptococcus pneumoniae to antibiotics and the sex of the patient: A systematic review and meta-analysis

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BACKGROUND: The spread of microbial resistance to antibiotics is a recent global problem, which has become more acute in recent years because of a significant increase in the consumption of antibiotics, against the background of the COVID-19 pandemic. A direct consequence of the spread of antibiotic-insensitive strains of pneumococci limits the treatment options for such patients and deterioration of the prognosis.

AIM: To determine whether sex is a factor associated with the development of diseases caused by antibiotic-resistant strains of Streptococcus pneumoniae.

MATERIALS AND METHODS: Using the electronic databases PubMed, ScienceDirect, and Google Scholar, a search was conducted for articles published from January 1980 to December 2020, and studies in English and Russian were selected. The selection of articles and meta-analysis was based on the recommendations of the PRISMA Group and MOOSE. After combining the data, the odds ratio (OR) was calculated with a 95% confidence interval (95% CI). Heterogeneity was assessed.

RESULTS: After applying the exclusion criteria, 41 publications covering 16635 patients with invasive and non-invasive forms of pneumococcal infection were selected for analysis. Of these, 36 case-control studies and 5 cross-sectional studies were identified. Accordingly, the sex of the patient does not affect the frequency of isolation of pneumococcal strains insensitive to penicillin (odds ratio [OR]=0.92, 95% confidence interval [CI] 0.82–1.03, I2=7%), resistant to penicillin (OR=0.85, 95% CI 0.67–1.07, I2=1%), and insensitive to erythromycin (OR=0.80, 95% CI 0.51–1.24, I2=0%). Male sex is associated with pneumococcal resistance to levofloxacin (OR=1.85, 95% CI 1.03–3.33, I2=0%).

CONCLUSIONS: The sex of the patient is not a factor associated with the isolation of S. pneumonia strains insensitive and resistant to penicillin and erythromycin. Moreover, the male sex probably increases the chance of isolation of levofloxacin-resistant pneumococci in adults with invasive pneumococcal infections.

作者简介

Sergey Semenov

Kazan State Medical University

Email: sergejsemenov596@gmail.com
ORCID iD: 0000-0003-3437-832X
SPIN 代码: 8774-6450
俄罗斯联邦, Kazan

Gulshat Khasanova

Kazan State Medical University

编辑信件的主要联系方式.
Email: gulshatra@mail.ru
ORCID iD: 0000-0002-1733-2576
SPIN 代码: 6704-2840
Scopus 作者 ID: 6507469219

MD, Dr. Sci. (Med.), Professor, Acad. RAS

俄罗斯联邦, Kazan

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2. Fig. 1. Strategy of search and selection of literature data for inclusion in meta-analysis.

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3. Fig. 2. Forest-plot: meta-analysis of the sensitivity of pneumococci to penicillin and the male sex of the patient. Events — number of cases (insensitive strains); Total — total number of patients; Weight — weighted effect size; Odds Ratio — odds ratio; M-H — Mantel–Hensel criterion; Random — random effects model; 95% CI — 95% confidence interval.

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4. Fig. 3. Forest-plot: meta-analysis of pneumococcal resistance to penicillin and the male sex of the patient. Events — number of cases (resistant strains); Total — total number of patients; Weight — weighted effect size; Odds Ratio — odds ratio; M–H — Mantel–Hensel criterion; Random — random effects model; 95% CI — 95% confidence interval.

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5. Fig. 4. Forest-plot: meta-analysis of pneumococcal resistance to levofloxacin and the male sex of the patient. Events — number of cases (resistant strains); Total — total number of patients; Weight — weighted effect size; Odds Ratio — odds ratio; M–H — Mantel–Hensel criterion; Random — random effects model; 95% CI — 95% confidence interval.

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6. Fig. 5. Forest-plot: meta-analysis of the sensitivity of pneumococci to macrolides and the male sex of the patient. Events — number of cases (resistant strains); Total — total number of patients; Weight — weighted effect size; Odds Ratio — odds ratio; M–H — Mantel–Hensel criterion; Random — random effects model; 95% CI — 95% confidence interval.

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