{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T04:46:55Z","timestamp":1779252415619,"version":"3.51.4"},"reference-count":74,"publisher":"Wiley","license":[{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Scientifica"],"published-print":{"date-parts":[[2021,5,27]]},"abstract":"<jats:p>Background. In recent years, antibiotic-resistant pathogens including penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) have posed serious threats against human health. The aim of this meta-analysis was to investigate the prevalence of Streptococcus pneumoniae drug resistance particularly the incidence of PNSP strains in Iran. Methods. A systematic search was done in national and international electronic databases using Persian and English keywords. Up until May 20, 2020, a total of 58 publications were detected as eligible articles based on the inclusion and exclusion criteria, and then the selected studies were enrolled for data extraction and meta-analysis according to the PRISMA guidelines. Results. A high rate of PNSP (46.9%) and multidrug-resistant (MDR) S. pneumoniae (45.3%) in our isolates were evident. Furthermore, total frequency resistance to other drugs in S. pneumoniae was as follows: erythromycin 41.1%, azithromycin 53.2%, tetracycline 39.9%, levofloxacin 1.7%, rifampin 1.2%, clindamycin 31.7%, vancomycin 1.7%, trimethoprim\/sulfamethoxazole 63.9%, chloramphenicol 20%, ceftriaxone 10.9%, amoxicillin 30.5%, ciprofloxacin 8.3%, imipenem 6.1%, linezolid 0%, and cefotaxime 8.3%. Conclusion. Although the overall prevalence of cephalosporin- and carbapenem-resistant Streptococcus pneumoniae was low, penicillin-resistant strains, especially PNSP, could become a significant challenge to the healthcare system in Iran. Hence, the prescription of penicillin as the first-choice antibiotic in the treatment of S. pneumoniae infections should be avoided.<\/jats:p>","DOI":"10.1155\/2021\/5573345","type":"journal-article","created":{"date-parts":[[2021,5,28]],"date-time":"2021-05-28T00:26:25Z","timestamp":1622161585000},"page":"1-12","source":"Crossref","is-referenced-by-count":8,"title":["Is Penicillin-Nonsusceptible Streptococcus pneumoniae a Significant Challenge to Healthcare System? A Systematic Review and Meta-Analysis"],"prefix":"10.1155","volume":"2021","author":[{"given":"Farzad","family":"Khademi","sequence":"first","affiliation":[{"name":"Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8656-1444","authenticated-orcid":true,"given":"Amirhossein","family":"Sahebkar","sequence":"additional","affiliation":[{"name":"Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran"},{"name":"Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran"},{"name":"School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","reference":[{"key":"1","first-page":"195","volume-title":"Medical Microbiology","author":"P. R. Murray","year":"2015","edition":"8th"},{"key":"2","first-page":"222","volume-title":"Jawetz Melnick & Adelbergs Medical Microbiology","author":"K. C. Carroll","year":"2016","edition":"27"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.000503"},{"key":"4","volume-title":"Pneumonia","author":"World Health Organization","year":"2014"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1016\/j.pop.2018.05.006"},{"key":"6","volume-title":"WHO Publishes List of Bacteria for Which New Antibiotics Are Urgently Needed","author":"World Health Organization","year":"2017"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000100"},{"issue":"2","key":"8","first-page":"118","article-title":"High frequency of macrolide-resistant Streptococcus pneumoniae colonization in respiratory tract of healthy children in Ardabil, Iran","volume":"18","author":"K. M. Gharibani","year":"2019","journal-title":"Tanaffos"},{"issue":"4","key":"9","first-page":"89","article-title":"The prevalence of Streptococcus pneumonia and its penicillin resistance pattern in children less than five years old from Shahrekord, Iran, 2007","volume":"10","author":"A. Khoshdel","year":"2009","journal-title":"Journal of Shahrekord University of Medical Sciences"},{"issue":"3","key":"10","first-page":"438","article-title":"Prevalence of antibiotic resistance among bacteria isolates of lower respiratory tract infection in COPD Shahrekord Iran, 2005","volume":"23","author":"R. Imani","year":"2007","journal-title":"Pakistan Journal of Medical Sciences"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.5812\/ircmj.17616"},{"issue":"4","key":"12","first-page":"17","article-title":"A five-year retrospective multicenter study on etiology and antibiotic resistance pattern of bacterial meningitis among Iranian children","volume":"5","author":"N. Hadi","year":"2019","journal-title":"Infection Epidemiology and Microbiology"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.1007\/s00580-014-1937-3"},{"issue":"4","key":"14","doi-asserted-by":"crossref","first-page":"968","DOI":"10.5897\/AJB11.2783","article-title":"Multi-drug resistance and molecular pattern of erythromycin and penicillin resistance genes in Streptococcus pneumoniae","volume":"11","author":"M. M. Kargar","year":"2012","journal-title":"African Journal of Biotechnology"},{"issue":"4","key":"15","first-page":"273","article-title":"Polymerase chain reaction, bacteriologic detection and antibiogram of bacteria isolated from otitis media with effusion in children, Shiraz, Iran","volume":"36","author":"M. Shishegar","year":"2011","journal-title":"Iranian Journal of Medical Sciences"},{"issue":"2","key":"16","first-page":"163","article-title":"Antibiotic-resistant bacteria in hospitalized patients with bloodstream infections: analysis of some associated factors","volume":"12","author":"A. Japoni","year":"2010","journal-title":"Iranian Red Crescent Medical Journal"},{"key":"17","doi-asserted-by":"publisher","DOI":"10.1159\/000096137"},{"issue":"1","key":"18","first-page":"16","article-title":"The prevalence of pneumococci throat carrier in healthy school children in Gorgan","volume":"13","author":"E. E. Ghaemi","year":"2002","journal-title":"Journal of Urmia University of Medical Sciences"},{"key":"19","doi-asserted-by":"publisher","DOI":"10.18869\/modares.iem.2.3.8"},{"issue":"1","key":"20","first-page":"18","article-title":"Study of bacterial agents of meningitis in children and detection of their antibiotic resistance patterns in hamadan, Western Iran","volume":"3","author":"R. Yousefi Mashouf","year":"2014","journal-title":"International Journal of Medical Investigation"},{"issue":"17","key":"21","first-page":"31","article-title":"Study of bacterial agents of meningitis in children and detection of antibiogram patterns in Hamadan","volume":"5","author":"R. Yousefi Mashouf","year":"2004","journal-title":"YAFTEH"},{"key":"22","first-page":"595","article-title":"Antimicrobial susceptibility and analysis of macrolide resistance genes in Streptococcus pneumoniae isolated in Hamadan","volume":"17","author":"M. N. Mosleh","year":"2014","journal-title":"Iranian Journal of Basic Medical Sciences"},{"issue":"10","key":"23","article-title":"Antimicrobial susceptibilities and distribution of resistance genes for \u03b2-lactams in Streptococcus pneumoniae isolated in Hamadan","volume":"7","author":"M. N. Mosleh","year":"2014","journal-title":"Jundishapur Journal of Microbiology"},{"issue":"5","key":"24","first-page":"469","article-title":"Bacteriological assessment of resistant effusional otitis media discharge among the 2-16 year-old children admitted to Matini hospital in Kashan, 2011-2013","volume":"18","author":"A. Yeganeh-Moghadam","year":"2014","journal-title":"Feyz Journal of Kashan University of Medical Sciences"},{"issue":"9","key":"25","first-page":"1284","article-title":"Serotyping, antibiotic susceptibility and related risk factors aspects of nasopharyngeal carriage of Streptococcus pneumoniae in healthy school students","volume":"43","author":"H. M. Ghazikalayeh","year":"2014","journal-title":"Iranian Journal of Public Health"},{"issue":"4","key":"26","first-page":"90","article-title":"Incidence of nasopharyngeal carriers of Streptococcus pneumoniae and antibiotic resistance in the children in Kermanshah 2012","volume":"4","author":"T. Sabory","year":"2016","journal-title":"Journal of Nursing Education - Healio"},{"issue":"8","key":"27","first-page":"741","article-title":"Bacteriological findings in patients with ocular infection and antibiotic susceptibility patterns of isolated pathogens","volume":"48","author":"A. D. Khosravi","year":"2007","journal-title":"Singapore Medical Journal"},{"issue":"1","key":"28","first-page":"608","article-title":"Frequency of Neonatal and children bacterial meningitis and determining their antibiotic sensitivity patterns in Hospitals of Iran","volume":"6","author":"N. Moafi","year":"2016","journal-title":"International Journal of Molecular and Clinical Microbiology"},{"key":"29","doi-asserted-by":"publisher","DOI":"10.2147\/idr.s220522"},{"key":"30","doi-asserted-by":"crossref","first-page":"333","DOI":"10.2147\/IDR.S234295","article-title":"Serotype distribution and antibiotic susceptibility of Streptococcus pneumoniae isolates in Tehran, Iran: a surveillance study","volume":"13","author":"S. H. Ghahfarokhi","year":"2020","journal-title":"Infection and Drug Resistance"},{"key":"31","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmni.2019.100597"},{"issue":"4","key":"32","first-page":"200","article-title":"Phenotypic and genotypic features of first biofilm forming nasopharyngeal colonized Streptococcus pneumoniae isolates","volume":"9","author":"S. F. Mousavi","year":"2017","journal-title":"Iranian Journal of Microbiology"},{"key":"33","doi-asserted-by":"publisher","DOI":"10.1089\/mdr.2017.0326"},{"key":"34","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2017.01.020"},{"key":"35","doi-asserted-by":"publisher","DOI":"10.1089\/mdr.2018.0336"},{"issue":"2","key":"36","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1097\/IPC.0000000000000554","article-title":"Streptococcus pneumoniae serotyping by a single polymerase chain reaction\u2013based multiplex assay","volume":"26","author":"M. S. Moghadam","year":"2018","journal-title":"Infectious Diseases in Clinical Practice"},{"key":"37","doi-asserted-by":"publisher","DOI":"10.1080\/10773525.2016.1201238"},{"key":"38","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2019.02.009"},{"issue":"1","key":"39","article-title":"Detection of pbp2b gene and antimicrobial susceptibility pattern of Streptococcus pneumoniae isolates in Tehran hospitals, Iran","volume":"5","author":"S. R. Tabatabaei","year":"2017","journal-title":"Archives of Pediatric Infectious Diseases"},{"key":"40","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0167803"},{"key":"41","doi-asserted-by":"publisher","DOI":"10.3343\/alm.2015.35.1.57"},{"key":"42","doi-asserted-by":"publisher","DOI":"10.5812\/jjm.13256"},{"key":"43","doi-asserted-by":"publisher","DOI":"10.1097\/ipc.0b013e31828bbb31"},{"issue":"98","key":"44","first-page":"28","article-title":"Frequency and resistance patterns of Streptococcus pneumoniae in acute otitis media","volume":"23","author":"M. M. Soltan Dallal","year":"2013","journal-title":"Journal of Mazandaran University of Medical Sciences"},{"key":"45","doi-asserted-by":"publisher","DOI":"10.1007\/s00284-014-0704-7"},{"issue":"1-2","key":"46","first-page":"15","article-title":"Differentiation of penicillin susceptible and nonsusceptible Streptococcus pneumoniae","volume":"4","author":"A. Ahmadi","year":"2015","journal-title":"Journal of Medical Bacteriology"},{"key":"47","doi-asserted-by":"publisher","DOI":"10.7883\/yoken.66.503"},{"key":"48","doi-asserted-by":"publisher","DOI":"10.1016\/j.anl.2011.07.002"},{"key":"49","doi-asserted-by":"publisher","DOI":"10.4103\/0974-9233.151870"},{"key":"50","doi-asserted-by":"publisher","DOI":"10.5812\/ircmj.8053"},{"issue":"8","key":"51","first-page":"500","article-title":"Nasopharyngeal carrier rate of Streptococcus pneumoniae in children: serotype distribution and antimicrobial resistance","volume":"15","author":"A. Sanaei Dashti","year":"2012","journal-title":"Archives of Iranian Medicine"},{"issue":"6","key":"52","first-page":"382","article-title":"Antimicrobial susceptibility trends among Streptococcus pneumoniae over an 11-year period in an Iranian referral children hospital","volume":"6","author":"M. T. Ashtiani","year":"2014","journal-title":"Iran Journal of Microbiology"},{"key":"53","doi-asserted-by":"publisher","DOI":"10.3855\/jidc.1517"},{"issue":"4","key":"54","first-page":"329","article-title":"Antibiotic susceptibility pattern of gram-positive cocci cultured from patients in three university hospitals in Tehran, Iran during 2001\u20132005","volume":"47","author":"M. Aligholi","year":"2009","journal-title":"Acta Medica Iranica"},{"issue":"1 and 2","key":"55","first-page":"9","article-title":"Molecular characterization of PBP2b in clinical isolates of Streptococcus pneumoniae","volume":"4","author":"M. Oskoui","year":"2010","journal-title":"Iranian Journal of Medical Microbiology"},{"issue":"3","key":"56","first-page":"223","article-title":"The resistance of Streptococcus pneumoniae against penicillin and other antibiotics","volume":"42","author":"S. A. H. Jahanmehr","year":"2004","journal-title":"Acta Medica Iranica"},{"issue":"3","key":"57","first-page":"192","article-title":"Drug susceptibility of Streptococcus pneumoniae strains isolated in Tehran, Iran","volume":"6","author":"M. Oskoui","year":"2003","journal-title":"Archives of Iranian Medicine"},{"issue":"2","key":"58","first-page":"131","article-title":"Antimicrobial susceptibility of bacteria isolated from cerebrospinal fluids in an Iranian referral pediatric center, 1998-2008","volume":"7","author":"G. Rezaeizadeh","year":"2012","journal-title":"Maedica"},{"issue":"1","key":"59","doi-asserted-by":"crossref","first-page":"44","DOI":"10.26719\/1998.4.1.44","article-title":"Bacterial etiologic agents of ocular infection in children in the Islmic Republic of Iran","volume":"4","author":"S. H. Modarres","year":"1998","journal-title":"East Mediterr Health Journal"},{"issue":"3","key":"60","first-page":"203","article-title":"Antimicrobial resistant pattern and capsular typing of Streptococcus pneumoniae isolated from children in Sistan\u2013Baluchestan","volume":"11","author":"Z. Gharailoo","year":"2016","journal-title":"M\u00e6dica."},{"issue":"1","key":"61","first-page":"28","article-title":"Serotype distribution and antimicrobial resistance of invasive Streptococcus pneumoniae isolates from children in Zahedan, Iran","volume":"6","author":"M. Bokaeian","year":"2012","journal-title":"African Journal of Microbiology Research"},{"issue":"5","key":"62","first-page":"328","article-title":"Nasopharyngeal carriage, antibiotic resistance and serotype distribution of Streptococcus pneumoniae among healthy adolescents in Zahedan","volume":"13","author":"M. Bokaeian","year":"2011","journal-title":"Iranian Red Crescent Medical Journal"},{"issue":"3","key":"63","first-page":"478","article-title":"Nosocomial blood stream infections in Imam Khomeini hospital, Urmia, Islamic Republic of Iran, 1999-2001","volume":"11","author":"M. Rahbar","year":"2005","journal-title":"Eastern Mediterranean health journal\u2009=\u2009La revue de sante de la Mediterranee orientale\u2009=\u2009al-Majallah al-sihhiyah li-sharq al-mutawassit"},{"issue":"1","key":"64","first-page":"65","article-title":"Prevalence of pharyngeal pneumococcal carriers and succeptibility patterns among children of day care centers in Yazd district, Iran","volume":"12","author":"F. Behnaz","year":"2004","journal-title":"JSSU"},{"issue":"2","key":"65","first-page":"17","article-title":"Determination of pneumococcal MIC to antibiotics in pneumococcus strains isolated from Zanjan hospitals","volume":"13","author":"A. Karami","year":"2009","journal-title":"JQUMS"},{"key":"66","doi-asserted-by":"publisher","DOI":"10.1097\/xeb.0000000000000054"},{"key":"67","doi-asserted-by":"crossref","first-page":"66","DOI":"10.2471\/BLT.15.152710","article-title":"An international legal framework to address antimicrobial resistance","volume":"93","author":"S. J. Hoffman","year":"2016","journal-title":"Bull World Health Organ"},{"key":"68","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2009.02724.x"},{"key":"69","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2019.00486"},{"key":"70","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-017-2880-0"},{"key":"71","doi-asserted-by":"publisher","DOI":"10.1097\/mjt.0000000000000551"},{"key":"72","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0154816"},{"key":"73","doi-asserted-by":"crossref","DOI":"10.15620\/cdc:82532","volume-title":"Antibiotic Resistance Threats in the United States","author":"Centers for Disease Control and Prevention","year":"2019"},{"key":"74","doi-asserted-by":"publisher","DOI":"10.1038\/nm1145"}],"container-title":["Scientifica"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/journals\/scientifica\/2021\/5573345.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/scientifica\/2021\/5573345.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/scientifica\/2021\/5573345.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,28]],"date-time":"2022-12-28T21:33:22Z","timestamp":1672263202000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.hindawi.com\/journals\/scientifica\/2021\/5573345\/"}},"subtitle":[],"editor":[{"given":"Abdel Halim","family":"Salem","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,5,27]]},"references-count":74,"alternative-id":["5573345","5573345"],"URL":"https:\/\/doi.org\/10.1155\/2021\/5573345","relation":{},"ISSN":["2090-908X"],"issn-type":[{"value":"2090-908X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,27]]}}}