Abstract
AbstractBackgroundThe rapid rise of nosocomial infections and the growing ineffectiveness of frontline antibiotics against Gram-negative bacteria (GNB) have put the healthcare sector under unprecedented stress. In this scenario, colistin, an antibiotic of the polymyxin class, has become the last resort treatment option. The unrestricted use of colistin in the preceding decades has led to the emergence of colistin-resistant (ColR) bacterial strains. Unfortunately, comprehensive data on the prevalence of ColRnosocomial pathogens in India are lacking. This study was conducted to address this information gap and to determine the prevalence of ColRamong the nosocomial GNB species in India.MethodsA systematic review and meta-analysis were conducted to determine the prevalence of ColRamong the nosocomial GNB species in India and their geographical distribution. A systematic search of the online databases was performed and eligible studies meeting the inclusion criteria were used for qualitative synthesis. The combined event rate and 95% confidence interval were estimated using forest plot with a random-effect model. Cochrane Q statistics and I2statistics were used to detect possible heterogeneity.ResultsFrom a total of 1865 retrieved records from 4 databases, 36 studies were included in the study. Among the most common nosocomial pathogens, K. pneumoniaeshowed a rate of ColRat 17.4%, followed byP. aeruginosa(14.1%),E. coli(12.3%), andA. baumannii(12.2%). Interestingly, our analysis revealed thatE. cloacaehas the highest rate of ColRat 28.5%.ConclusionsThe level of resistance displayed byK. pneumoniae,P. aeruginosa, and to a lesser extent,E. coliandA. baumanniiin the Indian subcontinent poses a challenge for public health management. Though prevalence may differ among regions and over time, continued surveillance, and efforts to curb the spread of resistance are crucial to ensure the continued effectiveness of this critical antibiotic.
Publisher
Cold Spring Harbor Laboratory