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Prevalence of polymyxin-resistant bacterial strains in India: a systematic review and meta-analysis
Sambit K Dwibedy1,2, Indira Padhy1, Aditya K Panda1,3
1Department of Biotechnology, Berhampur University, Bhanja Bihar, Berhampur 760007, Odisha, India.
Introduction:
Polymyxins, the cationic lipopeptide antibiotics, are the last line of therapeutics against the MDR Gram-negative bacterial (GNB) pathogens. Unfortunately, the rising cases of polymyxin-resistant strains from across the globe have adversely impacted their utility. While the molecular mechanisms responsible for developing polymyxin resistance (PolR) are largely understood, the prevalence of PolR strains in India has not been investigated systematically. The current study was undertaken to primarily determine the prevalence of PolR strains in India. Moreover, the extent of the spread of mobile colistin resistance (mcr) genes among the GNB strains in India was also determined.
Method:
A systematic search for articles using the relevant inclusion and exclusion criteria was performed in the applicable databases for the period January 2015 to December 2023. The included 41 studies were subjected to a meta-analysis using the Comprehensive Meta-Analysis software (V4.0). Publication biases were assessed using funnel plots and Egger's regression analysis.
Result:
Considering a total of 41 studies including 24 589 bacterial isolates the present meta-analysis found the rate of PolR bacteria in India to be at 15.0% (95% CI: 11.2 to 19.8). Among the Indian States, Tamil Nadu topped with the highest prevalence of PolR at 28.3%. Investigating the contribution of the mcr genes, it was observed that among the PolR strains, 8.4% (95% CI: 4.8 to 14.3) were mcr positive.
Conclusion:
The study determined the prevalence of PolR strains in India at 15.0%, which is higher than that of the global average at 10%. The study also determined that 8.4% of the PolR strains carried the mcr genes. The mcr-positive strains reported from India could be an underestimation of the actual numbers due to the non-inclusion of mcr screening in many previous studies. This study provides insight into the state of the PolR situation in India, which may be useful to develop a monitoring strategy to contain the spread of such strains and preserve the efficacy of the polymyxins.
Insights
Polymyxin resistance in India is 15.0%, higher than the global average. Mobile colistin resistance (mcr) genes were found in 8.4% of resistant strains, highlighting a need for monitoring and containment strategies.
Area of Science:
- Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Polymyxins are crucial last-resort antibiotics against multidrug-resistant Gram-negative bacteria.
- Rising global polymyxin resistance (PolR) threatens treatment efficacy.
- Systematic data on PolR prevalence in India was lacking.
Purpose of the Study:
- To determine the prevalence of polymyxin-resistant (PolR) Gram-negative bacterial (GNB) strains in India.
- To assess the prevalence of mobile colistin resistance (mcr) genes among GNB strains in India.
Main Methods:
- A systematic literature search was conducted for studies published between January 2015 and December 2023.
- A meta-analysis of 41 included studies, encompassing 24,589 bacterial isolates, was performed.
- Publication bias was assessed using funnel plots and Egger's regression analysis.
Main Results:
- The overall prevalence of PolR bacteria in India was found to be 15.0% (95% CI: 11.2 to 19.8).
- Tamil Nadu reported the highest PolR prevalence at 28.3% among Indian states.
- Mobile colistin resistance (mcr) genes were detected in 8.4% (95% CI: 4.8 to 14.3) of the PolR strains.
Conclusions:
- The prevalence of PolR strains in India (15.0%) exceeds the global average (10%).
- The presence of mcr genes in Indian strains may be underestimated due to inconsistent screening in prior studies.
- Findings underscore the need for a monitoring strategy to control PolR spread and preserve polymyxin effectiveness.
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