Prevalence of Colistin Resistance: A Worldwide Meta-Analysis

Abstract

Background: Colistin is an ancient class of antibiotic which works by rupturing the bacterial cell membrane. Bacteria have developed resistance against colistin antibiotic by various Lipopolysacchride modification mechanisms. Colistin has long been used as treatment option but its resistance is emerging in developing countries. Methodology: A systematic meta-analysis was performed to describe the prevalence of colistin resistance in different regions of the World. Web based search was conducted on platforms like Google scholar, PubMed, Scopus, Web of Science. Data was extracted from 2009-2019. Results: A total of 286 articles were identified from different electronic databases from which only 143 articles were selected based on our inclusion criteria. The overall pooled proportion of colistin resistance in different regions of the World was 0.21 (CI 95%: 0.20-0.21).  The overall significant heterogeneity was (I²= 99.54%, p < 0.001), significant ES=0 (z=62.53, p < 0.001). Bacterial isolates like Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli showed highest rates of colistin resistance. Conclusion: The performed meta-analysis showed the rates of colistin resistance worldwide. Asia showed high rates of Colsitin resistance. Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa were the most prevalent isolates. So, an appropriate and regular surveillance program is required and implementations of effective strategies is also needed that address colistin resistance and helps in controlling the spreading of colistin resistance.