Global Prevalence of Antibiotic-Resistant <i>Burkholderia pseudomallei</i> in Melioidosis Patients: A Systematic Review and Meta-Analysis
<b>Background</b>: <i>Burkholderia pseudomallei</i>, the causative agent of melioidosis, is intrinsically resistant to multiple antibiotics, posing substantial challenges for treatment. Reports of acquired resistance are increasing, underscoring the need for global surveillan...
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MDPI AG
2025-06-01
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| Series: | Antibiotics |
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| author | Jongkonnee Thanasai Sa-Ngob Laklaeng Supphachoke Khemla Khonesavanh Ratanavong Moragot Chatatikun Jitbanjong Tangpong Wiyada Kwanhian Klangbud |
| author_facet | Jongkonnee Thanasai Sa-Ngob Laklaeng Supphachoke Khemla Khonesavanh Ratanavong Moragot Chatatikun Jitbanjong Tangpong Wiyada Kwanhian Klangbud |
| author_sort | Jongkonnee Thanasai |
| collection | DOAJ |
| description | <b>Background</b>: <i>Burkholderia pseudomallei</i>, the causative agent of melioidosis, is intrinsically resistant to multiple antibiotics, posing substantial challenges for treatment. Reports of acquired resistance are increasing, underscoring the need for global surveillance. <b>Objective</b>: This systematic review and meta-analysis aimed to determine the global prevalence of antibiotic-resistant <i>B. pseudomallei</i> isolated from human clinical cases, with a focus on regional differences and variations in antimicrobial susceptibility testing methods. <b>Methods:</b> We systematically searched PubMed, Scopus, and Embase for studies reporting resistance in clinical <i>B. pseudomallei</i> isolates, following PRISMA guidelines. Pooled resistance rates to 11 antibiotics were calculated using a random-effect model. Subgroup analyses were performed based on geographical region and testing methodology (MIC vs. disk diffusion). <b>Results:</b> Twelve studies comprising 10,391 isolates were included. Resistance rates varied across antibiotics, with the highest pooled resistance observed for tigecycline (46.3%) and ciprofloxacin (38.3%). Ceftazidime (CAZ) and trimethoprim–sulfamethoxazole (SXT), commonly used first-line agents, showed resistance rates of 5.3% and 4.2%, respectively. Subgroup analyses of CAZ and SXT revealed significantly higher resistance in studies from Asia compared to Australia and America (<i>p</i> value < 0.0001). Disk diffusion methods tended to overestimate resistance compared to MIC-based approaches, which revealed non-significant differences for CAZ (<i>p</i> value = 0.5343) but significant differences for SXT (<i>p</i> value < 0.0001). <b>Conclusions:</b> Antibiotic resistance in <i>B. pseudomallei</i> exhibits regional variation and is influenced by the susceptibility testing method used. Surveillance programs and standardized antimicrobial susceptibility testing protocols are essential to guide effective treatment strategies and ensure accurate resistance reporting. |
| format | Article |
| id | doaj-art-d393f63593de4f8b9674ea20be5e6e3c |
| institution | Kabale University |
| issn | 2079-6382 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | MDPI AG |
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| series | Antibiotics |
| spelling | doaj-art-d393f63593de4f8b9674ea20be5e6e3c2025-08-20T03:55:48ZengMDPI AGAntibiotics2079-63822025-06-0114764710.3390/antibiotics14070647Global Prevalence of Antibiotic-Resistant <i>Burkholderia pseudomallei</i> in Melioidosis Patients: A Systematic Review and Meta-AnalysisJongkonnee Thanasai0Sa-Ngob Laklaeng1Supphachoke Khemla2Khonesavanh Ratanavong3Moragot Chatatikun4Jitbanjong Tangpong5Wiyada Kwanhian Klangbud6Faculty of Medicine, Mahasarakham University, Mahasarakham 44000, ThailandSchool of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, ThailandDivision of Infectious Diseases, Department of Internal Medicine, Nakhon Phanom Hospital, Nakhon Phanom 48000, ThailandSavannakhet Health Science College, Savanakhet 13000, LaosSchool of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, ThailandSchool of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, ThailandMedical Technology Program, Faculty of Science, Nakhon Phanom University, Nakhon Phanom 48000, Thailand<b>Background</b>: <i>Burkholderia pseudomallei</i>, the causative agent of melioidosis, is intrinsically resistant to multiple antibiotics, posing substantial challenges for treatment. Reports of acquired resistance are increasing, underscoring the need for global surveillance. <b>Objective</b>: This systematic review and meta-analysis aimed to determine the global prevalence of antibiotic-resistant <i>B. pseudomallei</i> isolated from human clinical cases, with a focus on regional differences and variations in antimicrobial susceptibility testing methods. <b>Methods:</b> We systematically searched PubMed, Scopus, and Embase for studies reporting resistance in clinical <i>B. pseudomallei</i> isolates, following PRISMA guidelines. Pooled resistance rates to 11 antibiotics were calculated using a random-effect model. Subgroup analyses were performed based on geographical region and testing methodology (MIC vs. disk diffusion). <b>Results:</b> Twelve studies comprising 10,391 isolates were included. Resistance rates varied across antibiotics, with the highest pooled resistance observed for tigecycline (46.3%) and ciprofloxacin (38.3%). Ceftazidime (CAZ) and trimethoprim–sulfamethoxazole (SXT), commonly used first-line agents, showed resistance rates of 5.3% and 4.2%, respectively. Subgroup analyses of CAZ and SXT revealed significantly higher resistance in studies from Asia compared to Australia and America (<i>p</i> value < 0.0001). Disk diffusion methods tended to overestimate resistance compared to MIC-based approaches, which revealed non-significant differences for CAZ (<i>p</i> value = 0.5343) but significant differences for SXT (<i>p</i> value < 0.0001). <b>Conclusions:</b> Antibiotic resistance in <i>B. pseudomallei</i> exhibits regional variation and is influenced by the susceptibility testing method used. Surveillance programs and standardized antimicrobial susceptibility testing protocols are essential to guide effective treatment strategies and ensure accurate resistance reporting.https://www.mdpi.com/2079-6382/14/7/647<i>Burkholderia pseudomallei</i>melioidosisantimicrobial resistanceantibiotic resistance surveillanceantimicrobial susceptibility testingpublic health |
| spellingShingle | Jongkonnee Thanasai Sa-Ngob Laklaeng Supphachoke Khemla Khonesavanh Ratanavong Moragot Chatatikun Jitbanjong Tangpong Wiyada Kwanhian Klangbud Global Prevalence of Antibiotic-Resistant <i>Burkholderia pseudomallei</i> in Melioidosis Patients: A Systematic Review and Meta-Analysis Antibiotics <i>Burkholderia pseudomallei</i> melioidosis antimicrobial resistance antibiotic resistance surveillance antimicrobial susceptibility testing public health |
| title | Global Prevalence of Antibiotic-Resistant <i>Burkholderia pseudomallei</i> in Melioidosis Patients: A Systematic Review and Meta-Analysis |
| title_full | Global Prevalence of Antibiotic-Resistant <i>Burkholderia pseudomallei</i> in Melioidosis Patients: A Systematic Review and Meta-Analysis |
| title_fullStr | Global Prevalence of Antibiotic-Resistant <i>Burkholderia pseudomallei</i> in Melioidosis Patients: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Global Prevalence of Antibiotic-Resistant <i>Burkholderia pseudomallei</i> in Melioidosis Patients: A Systematic Review and Meta-Analysis |
| title_short | Global Prevalence of Antibiotic-Resistant <i>Burkholderia pseudomallei</i> in Melioidosis Patients: A Systematic Review and Meta-Analysis |
| title_sort | global prevalence of antibiotic resistant i burkholderia pseudomallei i in melioidosis patients a systematic review and meta analysis |
| topic | <i>Burkholderia pseudomallei</i> melioidosis antimicrobial resistance antibiotic resistance surveillance antimicrobial susceptibility testing public health |
| url | https://www.mdpi.com/2079-6382/14/7/647 |
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