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Prevalence of Mutated Colistin-Resistant Klebsiella pneumoniae: A Systematic Review and Meta-Analysis

Nik Yusnoraini Yusof1, Nur Iffah Izzati Norazzman1, Siti Nur'ain Warddah Ab Hakim1,2

  • 1Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.

Tropical Medicine and Infectious Disease
|December 22, 2022
PubMed

Insights

Colistin resistance in Klebsiella pneumoniae is widespread, driven by genetic mutations. This study found a global prevalence of 75.4% for mutated colistin resistance, highlighting the urgent need for monitoring.

Area of Science:

  • Microbiology
  • Genetics
  • Public Health

Background:

  • Colistin resistance is a growing global health concern, particularly in Gram-negative bacteria like Klebsiella pneumoniae.
  • Genetic mutations in chromosomal genes and plasmid-mediated resistance are key drivers of colistin resistance.
  • Understanding the prevalence and genetic basis of colistin resistance in K. pneumoniae is crucial for effective treatment strategies.

Purpose of the Study:

  • To systematically review and meta-analyze the global prevalence of mutated colistin resistance in Klebsiella pneumoniae isolates.
  • To identify the specific genes frequently associated with colistin resistance mutations.
  • To provide an updated global perspective on the burden of colistin resistance in K. pneumoniae.

Main Methods:

  • A systematic literature search was performed across major scientific databases (PubMed, ScienceDirect, Scopus, Google Scholar).
  • Data from 50 selected articles were pooled and analyzed using Comprehensive Meta-Analysis Software (CMA).
  • Subgroup analyses were conducted to explore geographical variations in prevalence.

Main Results:

  • The pooled prevalence of mutated colistin resistance in K. pneumoniae was estimated at 75.4% (95% CI = 67.2–82.1), with high heterogeneity observed (I2 = 81.7%).
  • Saudi Arabia reported the highest prevalence (97.9%), while Egypt showed the lowest (4.5%).
  • The most frequently mutated genes were mgrB (88%), pmrB (54%), and phoQ (44%).

Conclusions:

  • A high prevalence of colistin resistance gene mutations in K. pneumoniae was confirmed globally.
  • The findings underscore the critical need for continuous surveillance and monitoring programs to curb the spread of colistin resistance.
  • Targeted interventions focusing on the identified key genes may be necessary for future control strategies.
Keywords:
Klebsiella pneumoniaecolistin resistancemeta-analysismutationsystematic review

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