Incidence and prevalence of polymyxin resistant bacterial strains in the clinical and environmental samples in India: a systematic review and meta-analysis

Abstract

AbstractIntroductionPolymyxins, the cationic lipopeptide antibiotics, are the last line of therapeutics against the multi-drug resistant (MDR) pathogenic Gram-negative bacteria. Unfortunately, the rising cases of polymyxin-resistant strains from across the globe have adversely impacted the available treatment options. While the molecular mechanisms responsible for developing polymyxin resistance (PolR) are largely understood, the prevalence of PolRstrains in India is not investigated systematically.MethodFor this study, a systematic search for relevant articles was performed in the applicable databases for the period January 2015 to December 2023. A meta-analysis was performed using the comprehensive meta-analysis software (V.4) to determine the overall prevalence of PolRbacterial strains in India. Publication biases were assessed using funnel plots and Egger’s regression analysis.ResultConsidering a total of 43 studies selected based on the relevant inclusion and exclusion criteria, the present meta-analysis found the rate of PolRbacteria in India to be at 15.7%, which is higher than the global average. Among the Indian States, Tamil Nadu topped with the highest prevalence of PolRat 32.4%. Investigating the contribution of the mobile colistin resistance (mcr) genes, it was observed that among the PolRstrains, 8.6 % weremcrpositive.ConclusionThemcr-positive strains reported from India could be an underestimation of the actual numbers due to the non-inclusion ofmcrscreening in many previous studies. Our study provides insight into the state of the PolRsituation in India, which may be useful to develop a monitoring strategy to contain the spread of such strains and preserve the potency of the polymyxins.