Multidrug Resistant Haemophilus influenzae Prevalence Increasing Worldwide

The global prevalence of multidrug resistant (MDR) Haemophilus influenzae has increased from 2003 to 2023, according to a study in BMC Infectious Diseases.

The findings are based on a systematic review and meta-analysis on the global antibiotic resistance of Haemophilus (H) influenzae based on geographic distribution.

Researchers performed a literature search in Medline, ISI Web of Science, Scopus, EMBASE, Google Scholar, and ProQuest. Eligible studies investigated the prevalence of MDR H influenzae in humans, were retrospective or cross-sectional, and evaluated antimicrobial/antibiotic susceptibility testing based on the Clinical and Laboratory Standards Institute guideline.

The meta-analysis included 16 studies published from 2003 to 2023. Data were incorporated from 19,787 H influenzae clinical isolates, encompassing H influenzae typed b (Hib) and non-Hib serotypes.

Antibiotic resistance trends of H influenzae included the following: amoxicillin, 6.3% (95% CI, 2.5-15; I²: 84.33; P =.01; Egger P =.01; Begg P =.02), ampicillin, 36% (95% CI, 25.6-48; I²: 94.38; P =.01; Egger P =.01; Begg P =.01), azithromycin, 15.3% (95% CI, 6.7-31.1; I²: 89.28; P =.01; Egger P =.03; Begg P =.05), chloramphenicol, 17.2% (95% CI, 10.3-27.1; I²: 90.59; P =.01; Egger P =.1; Begg P =.01), sulfamethoxazole, 45.6% (95% CI, 34.9-56.7; I²: 92.39; P =.01; Egger P =.2; Begg P =.3), and tetracycline, 19.9% (95% CI, 8.3-40.4; I²: 95.3; P =.01; Egger P =.08; Begg P =.1).

The overall prevalence of beta-lactamases producing H influenzae and MDR H influenzae was 34.9% (95% CI, 24.0-47.7; I²: 93.56; P =.01; Egger P =.01; Begg P =.01) and 23.1% (95% CI, 14.7-34.4; I²: 93.9; P =.01; Egger P =.04; Begg P =.01), respectively. Pooled prevalence rates of MDR H influenzae were 22.8% (95% CI, 13.0-36.8), 20.8% (95% CI, 16.5-25.9), and 27.8% (95% CI, 11.8-52.5) in 2003 to 2007, 2008 to 2012, and 2019 to 2023, respectively.

The prevalence of MDR H influenzae in Asian countries was significantly greater compared with the rate in Western regions, with rates of 24.6% (95% CI, 12.9-41.8) and 15.7% (95% CI, 6.7-32.6), respectively.

Based on infection type, the incidence of MDR H influenzae was highest in cases of meningitis (46.9%; 95% CI, 40.1-53.9), and the lowest prevalence was associated with cases of acute otitis media (0.5%; 95% CI, 0.0-7.4). For invasive infections, the overall prevalence of MDR H influenzae was 24.1% (95% CI, 12.0-42.5), and for acute respiratory infections the prevalence was 18.2% (95% CI, 6.6-41.1).

Study limitations include publication ‎bias and reliance on published data. Also, the studies varied in methodology, sample size, and demographic distribution.

“Our comprehensive meta-analysis shows an alarming increase in resistance, especially for beta-lactamase producing strains, which almost doubled from 2003 to 2023,” the study authors stated. “Although the rate of MDR H influenzae has remained relatively stable over the past 2 decades, its continued prevalence is particularly concerning in cases of meningitis.”

This article originally appeared on Pulmonology Advisor