Antibiotic resistance and bacterial co-infections in COVID-19 patients in Iran: a systematic review and meta-analysis of hospitalized and non-hospitalized cases
Abstract
BACKGROUND: The COVID-19 pandemic exacerbated antimicrobial resistance (AMR) in Iran, where up to 100% of hospitalized patients received antibiotics despite low bacterial co-infection rates. However, no comprehensive review has evaluated the burden of bacterial co-infections, antibiotic resistance (AR), and multi-drug resistance (MDR) across both hospitalized and non-hospitalized Iranian COVID-19 patients. This systematic review and meta-analysis aimed to determine the prevalence of bacterial infections, AR, and MDR during the COVID-19 era in Iran. METHODS: Following PRISMA 2020 guidelines, we systematically searched MEDLINE (PubMed), Embase, Scopus, Web of Science, and Iranian regional databases for studies published from January 2020 to March 2025. The review protocol was registered with the Open Science Framework (OSF; https://doi.org/10.17605/OSF.IO/SCBRX ). Fifteen studies comprising 36,403 COVID-19 patients—33,989 inpatients (including 22,875 treated in intensive-care units) and 2,414 outpatients—met the inclusion criteria. We combined results from multiple studies to determine overall rates of bacterial infections, antibiotic resistance, and multi-drug resistance, using methods that account for differences between studies. RESULTS: The pooled prevalence of bacterial co-infection among Iranian COVID-19 patients was 19.6% (95% CI: 17.8–21.4%) across hospitalized and non-hospitalized settings. Among hospitalized patients, secondary bacterial infections were predominantly…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 19 participants or records.
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