Carbapenem resistance and associated resistance genes in enterobacteriaceae and non-enterobacteriaceae in India: A systematic review and meta-analysis

Background and objectives Carbapenems are highly potent antibiotics, and the emergence and spread of carbapenem resistance is a major global public health challenge. This systematic review and meta-analysis investigated the prevalence of carbapenem resistance in Enterobacteriaceae and non-Enterobacteriaceae in India and delineated the spectrum of genes associated with carbapenem resistance in carbapenem-resistant organisms. Methods A comprehensive systematic review of available electronic databases was conducted in accordance with PRISMA guidelines. Studies on human samples from India reporting phenotypic and genotypic data for carbapenem-resistant Enterobacteriaceae (CRE) and carbapenem-resistant non-Enterobacteriaceae (CRNE) were included. Pooled prevalence rates were determined using a random effects model to account for heterogeneity. Data analyses were performed using Meta-Analysis Online software. Results A total of 45 studies met the inclusion criteria. The pooled prevalence of CRE was 9% (0.07-0.11) and CRNE was 16% (0.09-0.24), with marked heterogeneity (I2=99%, P