Polymyxin sensitivity/resistance cosmopolitan status, epidemiology and prevalence among O1/O139 and non-O1/non-O139 Vibrio cholerae: A meta-analysis

Bright E Igere; Hope Onohuean; Declan C Iwu; Etinosa O Igbinosa

doi:10.1016/j.imj.2023.11.004

Polymyxin sensitivity/resistance cosmopolitan status, epidemiology and prevalence among O1/O139 and non-O1/non-O139 Vibrio cholerae: A meta-analysis

Infect Med (Beijing). 2023 Nov 21;2(4):283-293. doi: 10.1016/j.imj.2023.11.004. eCollection 2023 Dec.

Authors

Bright E Igere^{1

2}, Hope Onohuean³, Declan C Iwu⁴, Etinosa O Igbinosa⁵

Affiliations

¹ Department of Biological Sciences, Microbiology Unit, Dennis Osadebay University, Asaba 320242, Nigeria.
² Biotechnology and Emerging Environmental Infections Pathogens Research Group (BEEIPREG), Department of Biological Sciences, Microbiology Unit, Dennis Osadebay University, Asaba 320242, Nigeria.
³ Biopharmaceutics unit, Department of Pharmacology and Toxicology, School of Pharmacy, Kampala International University Ishaka-Bushenyi Campus, Ishaka-Bushenyi 10101, Uganda.
⁴ Department of Microbiology, University of Pretoria, Pretoria 0002, South Africa.
⁵ Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin 300213, Nigeria.

Abstract

Resistance/sensitivity to polymyxin-B (PB) antibiotic has been employed as one among other epidemiologically relevant biotyping-scheme for Vibrio cholerae into Classical/El Tor biotypes. However, recent studies have revealed some pitfalls bordering on PB-sensitivity/resistance (PBR/S) necessitating study. Current study assesses the PBR/S cosmopolitan prevalence, epidemiology/distribution among O1/O139 and nonO1/nonO139 V. cholerae strains. Relevant databases (Web of Science, Scopus and PubMed) were searched to retrieve data from environmental and clinical samples employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Random-effect-model (REM) and common-effect-model (CEM) of meta-analysis was performed to determine prevalence of PBR/S V. cholerae strains, describe the cosmopolitan epidemiological potentials and biotype relevance. Heterogeneity was determined by meta-regression and subgroup analyses. The pooled analyzed isolates from articles (7290), with sensitive and resistance are 2219 (30.44%) and 5028 (69.56%). Among these PB-sensitive strains, more than 1944 (26.67%) were O1 strains, 132 (1.81%) were nonO1 strains while mis-reported Classical biotype were 2080 (28.53) respectively indicating potential spread of variant/dual biotype. A significant PB-resistance was observed in the models (CEM = 0.66, 95% CI [0.65; 0.68], p-value = 0.001; REM = 0.83 [0.74; 0.90], p = 0.001) as both models had a high level of heterogeneity (I² = 98.0%; $_{d f = 33}^{2} = 1755.09$ $, Q p = 2.4932$ ). Egger test (z = 5.4017, p < 0.0001) reveal publication bias by funnel plot asymmetry. The subgroup analysis for continents (Asia, Africa) and sources (acute diarrhea) revealed (98% CI (0.73; 0.93); 55% CI (0.20; 0.86)), and 92% CI (0.67; 0.98). The Epidemiological prevalence for El tor/variant/dual biotype showed 88% CI (0.78; 0.94) with O1 strains at 88% CI (0.78; 0.94). Such global prevalence, distribution/spread of phenotypes/genotypes necessitates updating the decades-long biotype classification scheme. An antibiotic stewardship in the post antibiotic era is suggestive/recommended. Also, there is need for holistic monitoring/evaluation of clinical/epidemiological relevance of the disseminating strains in endemic localities.

Keywords: Biotyping scheme; Clinical O1/O139 V. cholerae; Environmental nonO1/nonO139 V. cholerae; Global epidemiological relevance; PB-sensitive/PB-resistant strains; Polymyxin B.

Publication types

Review