Antibiotic resistance of Citrobacter freundii in clinical isolates: A systematic review and meta-analysis

Introduction: Citrobacter freundii (C. freundii) is an opportunistic infection agent in hospitalized patients, especially in the intensive care units (ICUs). The prevalence of antibiotic resistance in C. freundii is increasing in the worldwide, and this may cause significant clinical problems. This paper aims at evaluating the rate of antibiotic resistance of C. freundii using meta-analysis. Materials and methods: A total of eight qualified antibiotics in 21 published articles were chosen randomly to estimate the antibiotic resistance percentage of C. freundii in different countries. The data were analyzed by meta-analysis (random effect model) and the heterogeneity was determined using Cochran’s Q and I2 index. Also, Forest plot with confidence interval 95% were attained by R software. Results: Our data showed that the antibiotic resistance pattern of C. freundii in different parts of the world was not absolutely same but the maximum range of resistance was related to gentamicin and the minimum range of resistance was related to imipenem. Q and I2 were attained 45.25 (P<0.05) and 56%, respectively. Conclusion: The findings of this study showed that the variability in antibiotic resistance pattern of C. freundii in different studies across the world was due to heterogeneity in hygiene level that resulted from various geographic regions.