prevalence of tem-type extended spectrum beta lactamases in the iranian population: a systematic review and meta-analysis

Introduction: extended-spectrum β-lactamases (esbls) are enzymes produced by gram-negative bacteria, which confer resistance to many β-lactam antibiotics. among these, tem-type esbls, which are typically encoded by genes on plasmids, are highly prevalent and facilitate the spread among various bacterial species, leading to resistance against penicillins and cephalosporins. ongoing surveillance of the prevalence and characteristics of tem-esbls is crucial for informing antibiotic stewardship and implementing effective infection control measures to curb their dissemination. methods: this meta-analysis aimed to evaluate the overall prevalence of tem-type esbls in the iranian population derived from studies conducted from 2007 to 2020. relevant articles were systematically searched in pubmed, science direct, google scholar, biological abstracts, web of science, and sid databases, encompassing research from all iranian provinces. after applying inclusion criteria and screening titles and abstracts, a refined selection of articles was chosen for full-text review and data extraction. the data extracted were analyzed using statistical software, with subgroup analyses performed to investigate sources of heterogeneity. results: analysis of the 202 studies revealed an overall prevalence of 27% for tem-type esbls in iran. subgroup analysis indicated significant regional variations, with prevalence differing markedly among provinces. the highest prevalence was observed in qom province at 51%. by sample type, the prevalence was notably higher in urine and stool isolates, reaching 76%. among bacterial species, escherichia coli and klebsiella spp. exhibited the highest prevalence of tem-type esbls, with a combined rate of 43%. the peak prevalence was noted in studies from 2019, at 32%. conclusion: the high prevalence of antimicrobial resistance, particularly among gram-negative bacteria, represents a critical challenge to public health and calls for specific interventions to manage and reduce esbl spread. this study highlights the significant presence of tem-type esbls in iran, demonstrating the urgent need for enhanced surveillance and targeted interventions to address the variations in prevalence across different regions and sample types. the findings emphasize the importance of implementing robust antibiotic stewardship programs and stringent infection control measures to mitigate the dissemination of tem-type esbls and preserve the effectiveness of β-lactam antibiotics.