Prevalence of common diarrheagenic enterobacteriaceae in Iran (2000–2023): a systematic review and meta-analysis
Abstract Objective Bacterial gastroenteritis is a significant public health concern, capable of causing severe infections. Among the various pathogens involved, those belonging to the Enterobacteriaceae family are the most frequently isolated and associated with gastrointestinal disorders. This stud...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12876-025-03634-3 |
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| author | Mozhgan Derakhshan-Sefidi Fereshteh Eidy Somayyeh Nadi-Ravandi Sareh Bagheri-Josheghani Maryam Mirfakhraei |
| author_facet | Mozhgan Derakhshan-Sefidi Fereshteh Eidy Somayyeh Nadi-Ravandi Sareh Bagheri-Josheghani Maryam Mirfakhraei |
| author_sort | Mozhgan Derakhshan-Sefidi |
| collection | DOAJ |
| description | Abstract Objective Bacterial gastroenteritis is a significant public health concern, capable of causing severe infections. Among the various pathogens involved, those belonging to the Enterobacteriaceae family are the most frequently isolated and associated with gastrointestinal disorders. This study aimed to investigate the prevalence of common diarrheagenic Enterobacteriaceae in Iran over the past two decades, from 2000 to 2023. Methods A comprehensive systematic search was conducted across multiple databases, including EMBASE, HINARI, MEDLINE, PubMed, Google Scholar, and the Cochrane Library. The focus was on observational published studies reporting the prevalence of diarrheagenic Enterobacteriaceae in Iran during 2000 and 2023. The criteria did not restrict patient demographics such as age, gender, health conditions, or occupation. This meta-analysis employed a 95% confidence interval (CI) for analysis. Evidence of heterogeneity was determined using an I² value greater than 50%. To explore potential sources of heterogeneity, subgroup analysis and meta-regression analysis were performed. Statistical analyses were executed using R version 4.3.2 along with the meta package. A p-value less than 0.05 was considered statistically significant. Results Out of 3,701 papers reviewed, 56 studies met the inclusion criteria and were analyzed. The overall pooled prevalence of diarrheagenic Enterobacteriaceae species from 2000 to 2023 was 14.0% (95% CI: 0.11–0.17). Subgroup analysis revealed Shigella spp. had the highest prevalence at 18.0% (95% CI: 0.13–0.24; I²=99%), followed by diarrheagenic Escherichia coli at 11.0% (95% CI: 0.09–0.15; I²=97%), Salmonella spp. at 9.0% (95% CI: 0.05–0.17; I²=99%), and Yersinia spp. at 2.0% (95% CI: 0.00-0.10; I²=94%). Prevalence trends showed Shigella spp. increasing from 4% (95% CI: 0.03–0.08) in 2000–2004 to 36% (95% CI: 0.20–0.55) in 2021–2023. Diarrheagenic E. coli (DEC) showed no clear pattern, ranging from 5% (95% CI: 0.01–0.24) to 17% (95% CI: 0.07–0.36). Salmonella spp. exhibited more significant fluctuations, rising from 6% (95% CI) in both 2000–2004 and 2005–2008 periods to 20% (95% CI: 0.03–0.66) in 2009–2012 and 30% (95% CI: 0.11–0.60) in 2017–2020. Yersinia spp. was only determined in 2000–2004 with a pool prevalence of 12% (95% CI: 0.00-0.91). Sub-species analysis revealed Shigella sonnei was the most prevalent species among Shigella spp. in Iran, accounting for 42% of cases (95% CI: 0.33–0.52). Regarding DEC species, Enteroaggregative E. coli (EAEC) and Enterotpathogenic E. coli (EPEC) had the highest rate at 15% (95% CI). Furthermore, a pool prevalence of 2% (95% CI: 0.00-0.89) was reported for Yersinia enterocolitica among diarrheagenic Enterobacteriaceae in Iran. Conclusion This meta-analysis provides valuable insights into the prevalence of diarrheagenic Enterobacteriaceae in Iran over the past two decades. The findings highlight the significant impact of these pathogens on public health, with Shigella spp. showing the highest prevalence and increasing trends. Further research should investigate the factors contributing to the prevalence of diarrheagenic Enterobacteriaceae, including genetic diversity of diarrheagenic Enterobacteriaceae isolates, molecular mechanisms underlying the virulence of these pathogens, or antibiotic resistance patterns. |
| format | Article |
| id | doaj-art-222c42de037f4456ab2c296168bff900 |
| institution | Kabale University |
| issn | 1471-230X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Gastroenterology |
| spelling | doaj-art-222c42de037f4456ab2c296168bff9002025-02-02T12:27:09ZengBMCBMC Gastroenterology1471-230X2025-01-0125111910.1186/s12876-025-03634-3Prevalence of common diarrheagenic enterobacteriaceae in Iran (2000–2023): a systematic review and meta-analysisMozhgan Derakhshan-Sefidi0Fereshteh Eidy1Somayyeh Nadi-Ravandi2Sareh Bagheri-Josheghani3Maryam Mirfakhraei4Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares UniversityCenter for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical SciencesHealth Information Management Research Center, Kashan University of Medical SciencesInfectious Diseases Research Center, Kashan University of Medical SciencesDepartment of Biostatistics, Payame Noor UniversityAbstract Objective Bacterial gastroenteritis is a significant public health concern, capable of causing severe infections. Among the various pathogens involved, those belonging to the Enterobacteriaceae family are the most frequently isolated and associated with gastrointestinal disorders. This study aimed to investigate the prevalence of common diarrheagenic Enterobacteriaceae in Iran over the past two decades, from 2000 to 2023. Methods A comprehensive systematic search was conducted across multiple databases, including EMBASE, HINARI, MEDLINE, PubMed, Google Scholar, and the Cochrane Library. The focus was on observational published studies reporting the prevalence of diarrheagenic Enterobacteriaceae in Iran during 2000 and 2023. The criteria did not restrict patient demographics such as age, gender, health conditions, or occupation. This meta-analysis employed a 95% confidence interval (CI) for analysis. Evidence of heterogeneity was determined using an I² value greater than 50%. To explore potential sources of heterogeneity, subgroup analysis and meta-regression analysis were performed. Statistical analyses were executed using R version 4.3.2 along with the meta package. A p-value less than 0.05 was considered statistically significant. Results Out of 3,701 papers reviewed, 56 studies met the inclusion criteria and were analyzed. The overall pooled prevalence of diarrheagenic Enterobacteriaceae species from 2000 to 2023 was 14.0% (95% CI: 0.11–0.17). Subgroup analysis revealed Shigella spp. had the highest prevalence at 18.0% (95% CI: 0.13–0.24; I²=99%), followed by diarrheagenic Escherichia coli at 11.0% (95% CI: 0.09–0.15; I²=97%), Salmonella spp. at 9.0% (95% CI: 0.05–0.17; I²=99%), and Yersinia spp. at 2.0% (95% CI: 0.00-0.10; I²=94%). Prevalence trends showed Shigella spp. increasing from 4% (95% CI: 0.03–0.08) in 2000–2004 to 36% (95% CI: 0.20–0.55) in 2021–2023. Diarrheagenic E. coli (DEC) showed no clear pattern, ranging from 5% (95% CI: 0.01–0.24) to 17% (95% CI: 0.07–0.36). Salmonella spp. exhibited more significant fluctuations, rising from 6% (95% CI) in both 2000–2004 and 2005–2008 periods to 20% (95% CI: 0.03–0.66) in 2009–2012 and 30% (95% CI: 0.11–0.60) in 2017–2020. Yersinia spp. was only determined in 2000–2004 with a pool prevalence of 12% (95% CI: 0.00-0.91). Sub-species analysis revealed Shigella sonnei was the most prevalent species among Shigella spp. in Iran, accounting for 42% of cases (95% CI: 0.33–0.52). Regarding DEC species, Enteroaggregative E. coli (EAEC) and Enterotpathogenic E. coli (EPEC) had the highest rate at 15% (95% CI). Furthermore, a pool prevalence of 2% (95% CI: 0.00-0.89) was reported for Yersinia enterocolitica among diarrheagenic Enterobacteriaceae in Iran. Conclusion This meta-analysis provides valuable insights into the prevalence of diarrheagenic Enterobacteriaceae in Iran over the past two decades. The findings highlight the significant impact of these pathogens on public health, with Shigella spp. showing the highest prevalence and increasing trends. Further research should investigate the factors contributing to the prevalence of diarrheagenic Enterobacteriaceae, including genetic diversity of diarrheagenic Enterobacteriaceae isolates, molecular mechanisms underlying the virulence of these pathogens, or antibiotic resistance patterns.https://doi.org/10.1186/s12876-025-03634-3EnterobacteriaceaeGastroenteritisMeta-analysisPrevalenceIran |
| spellingShingle | Mozhgan Derakhshan-Sefidi Fereshteh Eidy Somayyeh Nadi-Ravandi Sareh Bagheri-Josheghani Maryam Mirfakhraei Prevalence of common diarrheagenic enterobacteriaceae in Iran (2000–2023): a systematic review and meta-analysis BMC Gastroenterology Enterobacteriaceae Gastroenteritis Meta-analysis Prevalence Iran |
| title | Prevalence of common diarrheagenic enterobacteriaceae in Iran (2000–2023): a systematic review and meta-analysis |
| title_full | Prevalence of common diarrheagenic enterobacteriaceae in Iran (2000–2023): a systematic review and meta-analysis |
| title_fullStr | Prevalence of common diarrheagenic enterobacteriaceae in Iran (2000–2023): a systematic review and meta-analysis |
| title_full_unstemmed | Prevalence of common diarrheagenic enterobacteriaceae in Iran (2000–2023): a systematic review and meta-analysis |
| title_short | Prevalence of common diarrheagenic enterobacteriaceae in Iran (2000–2023): a systematic review and meta-analysis |
| title_sort | prevalence of common diarrheagenic enterobacteriaceae in iran 2000 2023 a systematic review and meta analysis |
| topic | Enterobacteriaceae Gastroenteritis Meta-analysis Prevalence Iran |
| url | https://doi.org/10.1186/s12876-025-03634-3 |
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