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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
A systematic review and meta-analysis: rising prevalence of colistin resistance in ICU-acquired Gram-negative
Na Li1, Elaheh Ebrahimi2, Mohammad Sholeh3
1Zhejiang Provincial Headquarters Hospital of the Chinese People's Armed Police Force Zhejiang, Hangzhou, China.
Abstract:
Colistin is a last-resort treatment for multidrug-resistant Gram-negative bacterial infections, particularly in critically ill patients. Nevertheless, it remains a major threat to public health. We assessed the proportion of colistin-resistant Gram-negative isolates from intensive care unit (ICU) infections in different years, areas, pathogens, and antimicrobial susceptibility tests (AST). We searched the studies in PubMed, Scopus, Embase, and Web of Science (until November 2021). Statistical analyses were conducted using STATA software (ver. 14.0). The overall rate of colistin resistance was 5.18% (95% CI 2.70%-8.22%). The proportion of colistin resistance was 4% (95% CI 2%-7%) before 2015 and 6% (95% CI 4%-9%) in 2015-2019. The rates of colistin resistance in Europe, America, Asia, and Africa were 8.24%, 3.78%, 3.60%, and 0%, respectively. The proportion of colistin-resistant non-fermenting Gram-negative bacilli isolated from the ICU was 2.25% (Acinetobacter baumannii [1.68%] and Pseudomonas aeruginosa [3.30%]). A 4-fold increase in colistin resistance was observed when comparing EUCAST and CLSI. We described the global epidemiology of colistin resistance over time and shown the distribution of colistin-resistant strains in different countries. Robust antimicrobial stewardship programs can increase the success of ICU physicians in improving patient outcomes.
Insights
Colistin resistance in Gram-negative bacteria is a growing public health concern. This study found an overall resistance rate of 5.18%, highlighting the need for robust antimicrobial stewardship programs.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Colistin is a critical last-resort antibiotic for multidrug-resistant Gram-negative infections.
- Rising colistin resistance poses a significant threat to public health, especially in intensive care units (ICUs).
Purpose of the Study:
- To assess the global prevalence and trends of colistin resistance in Gram-negative bacteria from ICU infections.
- To analyze resistance rates across different geographical regions, time periods, pathogens, and antimicrobial susceptibility testing (AST) methods.
Main Methods:
- Systematic literature review of studies published until November 2021 in PubMed, Scopus, Embase, and Web of Science.
- Meta-analysis of colistin resistance proportions using STATA software (ver. 14.0).
Main Results:
- The overall colistin resistance rate was 5.18%. Resistance increased from 4% before 2015 to 6% between 2015-2019.
- Geographical variations were observed: Europe (8.24%), America (3.78%), Asia (3.60%), and Africa (0%).
- Colistin resistance was 2.25% in non-fermenting Gram-negative bacilli (Acinetobacter baumannii: 1.68%, Pseudomonas aeruginosa: 3.30%). A 4-fold difference in resistance was noted between EUCAST and CLSI AST methods.
Conclusions:
- Global colistin resistance is increasing, with significant geographical disparities.
- Effective antimicrobial stewardship programs are essential for improving patient outcomes in ICUs facing colistin resistance challenges.
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