{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:57:48Z","timestamp":1787313468641,"version":"build-2736575974"},"reference-count":84,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Macrolide resistance in\n                      <jats:italic>Mycobacterium<\/jats:italic>\n                      species is an emerging global problem, complicating treating non-tuberculous mycobacteria (NTM) and\n                      <jats:italic>Mycobacterium tuberculosis<\/jats:italic>\n                      . Understanding global resistance patterns is essential to improve treatment strategies and reduce morbidity and mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      This study aimed to investigate macrolide resistance prevalence, distribution, and trends among\n                      <jats:italic>Mycobacterium<\/jats:italic>\n                      species in different world regions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive search of Scopus, PubMed, Web of Science, and EMBASE (2015\u20132023) assessed study quality using JBI guidelines. Resistance proportions were calculated with a random-effects model, and additional meta-regression and subgroup analyses explored variations and trends. Statistical analyses were conducted using R and the metafor package.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of 5,718 records, 41 studies across 17 countries were included. Azithromycin resistance was reported in 17 reports (3 Studies), with 156 resistant isolates among 715 tested, yielding a pooled rate of 29.0% (95% CI: 19.5\u201340.7%). Clarithromycin resistance, assessed in 76 reports (40 Studies), included 1,071 resistant isolates among 3,923 tested, with a pooled rate of 30.5% (95% CI: 23.7\u201338.2%). Erythromycin resistance was reported in 17 reports (3 Studies), with 350 resistant isolates among 752 tested, giving a pooled rate of 50.3% (95% CI: 37.5\u201362.9%). Meta-regression revealed a significant upward trend in azithromycin resistance over time (r\u2009=\u20090.558, p\u2009=\u20090.005).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      These findings underscore the need for targeted, region- and species-specific interventions to combat rising macrolide resistance in\n                      <jats:italic>Mycobacterium<\/jats:italic>\n                      species effectively.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0333521","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T18:34:06Z","timestamp":1762540446000},"page":"e0333521","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Global trends in the proportion of macrolide-resistant Mycobacterium Species: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"20","author":[{"given":"Saeid Sadeghi","family":"Ghazi Chaki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed 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