Multidrug-Resistant Virulence Genes in Isolates of Pseudomonas aeruginosa in Iranian Clinical Samples: A Review-Meta-Analysis

Background and purpose: Pseudomonas infections include urinary tract infections (UTIs), respiratory infections, soft tissue infections, dermatitis, bacteremia, gastrointestinal, bone and joint infections, and systemic types of infections, especially in hospitalized patients with severe burns, or patients with immunosuppression such as cancer or AIDS. Considering the importance of the virulence genes of Pseudomonas aeruginosa and the drug resistance that can be caused by this bacterium, the purpose of this study was to investigate the prevalence of multidrug-resistant virulence genes in isolates of P. aeruginosa in Iranian clinical samples. Materials and methods: Using Scopus, ISI, Web of science, Pubmed, and Web of science databases, the following were used as keywords: phzM, phzH, phzII, phzI, phzS, plcH, plcN, algD, algU, pilB, and pilA. After limiting the search strategy and removing duplicates, the remaining articles were screened by examining the titles and abstracts. Finally, the heterogeneity index between studies was determined using Cochran's test (Q) and I2. Based on this information, the fixed effect model was used to estimate the prevalence of Pseudomonas infection. Results: In 26 studies included in the meta-analysis, the frequencies of phzM, phzH, phzII, phzI, phzS, plcH, plcN, algD, algU, pilB, and pilA genes based on random effect model were 39.6%, 38.5%, 57%, 53.1%, 41%, 77.8%, 58.3%, 61.6%, 74%, 25.5%, and 25.5%, respectively. Conclusion: This study showed presence of genes encoding virulence factors (phzM, phzH, phzII, phzI, phzS, plcH, plcN, algD, algU, pilB, and pilA) in clinical strains of P. aeruginosa. In general, different types of virulence genes of this bacterium indicate that these genes are linked to severity of pathogenicity.