犬外耳炎分离葡萄球菌属抗菌药物耐药性的全球流行情况：系统综述与荟萃分析（1995-2024）

文献信息

中文摘要

背景： 与犬外耳炎（COE）相关的葡萄球菌属抗菌药物耐药性（AMR）对兽医实践和公共卫生构成日益严峻的挑战。我们遵循PRISMA指南进行了系统综述与荟萃分析，以估计COE中葡萄球菌属的全球AMR流行率，并考察其按抗菌药物类别、药物、菌种和洲别的变异。方法：在四个电子数据库中进行了文献检索，以识别报告COE葡萄球菌分离株抗菌药物敏感性的观察性研究。28项发表于1995年至2024年的研究，共包含22,864株分离株，符合纳入标准。进行了随机效应荟萃分析。结果：葡萄球菌属的总体合并AMR流行率为33.83%，异质性高。β-内酰胺类显示最高的合并耐药率（60.32%；95% CI：47.85,71.58），甲氧西林耐药与第三代头孢菌素耐药之间存在显著差异。菌种水平分析显示，氨基糖苷类和氟喹诺酮类药物存在显著的种间差异。洲别水平分析显示特定抗生素类别存在变异（p < 0.01），耐药率在南美洲持续达到峰值，在非洲保持最低，而β-内酰胺类耐药性显示出惊人的全球一致性（p = 0.70）。荟萃回归显示发表年份与AMR之间存在显著正相关（QM = 18.95，p < 0.0001；系数 = 每年0.0561）。结论：总之，我们的研究结果表明，COE中葡萄球菌属的AMR相当严重，因类别和菌种而异，并显示出随时间增加的趋势以及明显的区域异质性。这些发现强调需要本地监测网络、加强抗菌药物管理、标准化诊断方案以及One Health方法来减轻AMR对动物和人类健康的风险。

英文摘要

Antimicrobial resistance (AMR) in Staphylococcus spp. associated with canine otitis externa (COE) represents an increasing challenge for veterinary practice and public health. We conducted a systematic review and meta-analysis following PRISMA guidelines to estimate global AMR prevalence in Staphylococcus spp. from COE and to examine variation by antimicrobial class, agent, species, and continent. A literature search was conducted in four electronic databases to identify observational studies reporting antimicrobial susceptibility of Staphylococcus isolates from COE. Twenty-eight studies published between 1995 and 2024, comprising 22,864 isolates, met the inclusion criteria. Random-effects meta-analyses were performed. The overall pooled AMR prevalence among Staphylococcus spp. was 33.83% with high heterogeneity. Beta-lactams showed the highest pooled resistance (60.32%; 95% CI: 47.85,71.58), with a significant difference between methicillin resistance and third-generation cephalosporin resistance. Species-level analyses revealed significant interspecies differences for aminoglycosides and fluoroquinolones. Continent-level analysis revealed variation in specific antibiotic classes (p < 0.01), with resistance consistently peaking in South America and remaining lowest in Africa, whereas beta-lactam resistance showed striking global uniformity (p = 0.70). Meta-regression showed a significant positive association between publication year and AMR (QM = 18.95, p < 0.0001; coefficient = 0.0561 per year). In conclusion, our findings indicate that AMR among Staphylococcus spp. from COE is substantial, varies by class and species, and shows an increasing temporal trend alongside marked regional heterogeneity. These findings underscore the need for local surveillance networks, strengthened antimicrobial stewardship, standardized diagnostic protocols, and a One Health approach to mitigate AMR risks to animal and human health.