Global Prevalence of Colistin Resistance in Klebsiella pneumoniae from Bloodstream Infection: A Systematic Review and Meta-Analysis

Leonard Ighodalo Uzairue 1 2, Ali A Rabaan 3 4 5, Fumilayo Ajoke Adewumi 6, Obiageli Jovita Okolie 7, Jamiu Bello Folorunso 8, Muhammed A Bakhrebah 9, Mohammed Garout 10, Wadha A Alfouzan 11 12, Muhammad A Halwani 13, Aref A Alamri 14, Shaima A Halawani 14, Fatimah S Alshahrani 15, Abdulkarim Hasan 16 17, Abbas Al Mutair 18 19 20 21, Saad Alhumaid 22, Johnson Etafo 23, Idorenyin Utip 24, Ikenna Maximillian Odoh 25, Nkolika S Uwaezuoke 26

Affiliations

24 September 2022

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doi: 10.3390/pathogens11101092

Abstract

Background: Among gram-negative bacteria, Klebsiella pneumoniae is one of the most common causes of healthcare-related infection. Bloodstream infections (BSIs) caused by Klebsiella pneumoniae are notorious for being difficult to treat due to resistance to commonly used antimicrobials. Klebsiella pneumoniae isolates from bloodstream infections are becoming increasingly resistant to carbapenems. In the fight against carbapenem-resistant Klebsiella pneumoniae, colistin [polymyxin E] is the antimicrobial of choice and is thus widely used. Objective: This study aimed to determine the global prevalence of colistin resistance amongst Klebsiella pneumoniae isolates from bloodstream infections. 

Methods: PubMed, Medline, Scopus, and the Cochrane Library were searched for published articles without restricting the search period. Studies meeting the predefined inclusion and exclusion criteria were included, and quality was assessed using Joanna Briggs Institute Checklist. We used a statistical random effect model to analyze data with substantial heterogeneity (I2 > 50%) in the meta-analysis. Results: A total of 10 studies out of 2873 search results that met the inclusion criteria were included in the final synthesis for this study. A pooled prevalence of colistin resistance was 3.1%, 95% CI (1.5−4.7%). The highest colistin resistance pooled prevalence was recorded in isolates studied in 2020 and beyond 12.90% (4/31), while Klebsiella pneumoniae isolates studied in 2015 and before and in 2016−2019 showed a pooled colistin resistance rate of 2.89% (48/1661) and 2.95% (28/948), respectively. The highest colistin resistance was found in Klebsiella pneumoniae isolates from Thailand (19.2%), while the least pooled resistance was in Klebsiella pneumoniae from South Korea (0.8%). The pooled prevalence of the multidrug-resistant (MDR) of Klebsiella pneumoniae from bloodstream infection ranged from 80.1%, 95% CI (65.0−95.2%), and the resistance prevalence of other antibiotics by Klebsiella pneumoniae from bloodstream infections were as follows; ciprofloxacin (45.3%), ertapenem (44.4%), meropenem (36.1%), imipenem (35.2%), gentamicin (33.3%), amikacin (25.4%) and tigecycline (5.1%). Klebsiella pneumoniae recovered from the intensive care unit (ICU) showed higher colistin resistance, 11.5% (9/781%), while non-ICU patients showed 3.03% (80/2604) pooled colistin resistance. 

Conclusion: This study showed low colistin resistance in Klebsiella pneumoniae isolates from global bloodstream infections. However, significant colistin resistance was observed in isolates collected from 2020 and beyond. Significant colistin resistance was also observed in Klebsiella pneumoniae isolates in bloodstream infections from the intensive care unit (ICU) compared to those from non-ICUs. As a result, there is a need to institute colistin administration stewardship in the ICU in clinical settings.

Keywords: Klebsiella pneumoniae; bloodstream infection; colistin-resistance; multi-drug resistance; prevalence.

Conflict of interest statement

The authors declare no conflict of interest.

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References

  1.  
    1. Nagvekar V., Sawant S., Amey S. Prevalence of multidrug-resistant Gram-negative bacteria cases at admission in a multispeciality hospital. J. Glob. Antimicrob. Resist. 2020;22:457–461. doi: 10.1016/j.jgar.2020.02.030. - DOI - PubMed
  2.  
    1. Navon-Venezia S., Kondratyeva K., Carattoli A. Klebsiella pneumoniae: A major worldwide source and shuttle for antibiotic resistance. FEMS Microbiol. Rev. 2017;41:252–275. doi: 10.1093/femsre/fux013. - DOI - PubMed
  3.  
    1. Kazi M., Drego L., Nikam C., Ajbani K., Soman R., Shetty A., Rodrigues C. Molecular characterization of carbapenem-resistant Enterobacteriaceae at a tertiary care laboratory in Mumbai. Eur. J. Clin. Microbiol. Infect. Dis. 2015;34:467–472. doi: 10.1007/s10096-014-2249-x. - DOI - PubMed
  4.  
    1. Dixit A., Kumar N., Kumar S., Trigun V. Antimicrobial Resistance: Progress in the Decade since Emergence of New Delhi Metallo-β-Lactamase in India. Indian J. Community Med. 2019;44:4–8. doi: 10.4103/ijcm.IJCM_217_18. - DOI - PMC - PubMed
  5.  
    1. Gandra S., Mojica N., Klein E., Ashok A., Nerurkar V., Kumari M., Ramesh U., Dey S., Vadwai V., Das B.R., et al. Trends in antibiotic resistance among major bacterial pathogens isolated from blood cultures tested at a large private laboratory network in India, 2008–2014. Int. J. Infect. Dis. 2016;50:75–82. doi: 10.1016/j.ijid.2016.08.002. - DOI - PMC - PubMed
  6.  
    1. Azam M., Gaind R., Yadav G., Sharma A., Upmanyu K., Jain M., Singh R. Colistin Resistance Among Multiple Sequence Types of Klebsiella pneumoniae Is Associated With Diverse Resistance Mechanisms: A Report from India. Front. Microbiol. 2021;12:609840. doi: 10.3389/fmicb.2021.609840. - DOI - PMC - PubMed
  7.  
    1. Monaco M., Giani T., Raffone M., Arena F., Garcia-Fernandez A., Pollini S., Collective Network EuSCAPE-Italy. Grundmann H., Pantosti A., Rossolini G.M. Colistin resistance superimposed to endemic carbapenem-resistant Klebsiella pneumoniae: A rapidly evolving problem in Italy, November 2013 to April 2014. Eurosurveillance. 2014;19:20939. doi: 10.2807/1560-7917.ES2014.19.42.20939. - DOI - PubMed
  8.  
    1. Giacobbe D., Del Bono V., Trecarichi E., De Rosa F., Giannella M., Bassetti M., Bartoloni A., Losito A., Corcione S., Bartoletti M., et al. Risk factors for bloodstream infections due to colistin-resistant KPC-producing Klebsiella pneumoniae: Results from a multicenter case–control–control study. Clin. Microbiol. Infect. 2015;21:1106.e1–1106.e8. doi: 10.1016/j.cmi.2015.08.001. - DOI - PubMed
  9.  
    1. Hazırolan G., Karagöz A. Emergence of carbapenemase-producing and colistin resistant Klebsiella pneumoniae ST101 high-risk clone in Turkey. Acta Microbiol. Immunol. Hung. 2020;67:216–221. doi: 10.1556/030.2020.01275. - DOI - PubMed
  10.  
    1. Karaiskos I., Lagou S., Pontikis K., Rapti V., Poulakou G. The “Old” and the “New” antibiotics for MDR Gram-negative pathogens: For whom, when, and how. Front. Public Health. 2019;7:151. doi: 10.3389/fpubh.2019.00151. - DOI - PMC - PubMed
  11.  
    1. Morris S., Cerceo E. Trends, Epidemiology, and Management of Multi-Drug Resistant Gram-Negative Bacterial Infections in the Hospitalized Setting. Antibiot. 2020;9:196. doi: 10.3390/antibiotics9040196. - DOI - PMC - PubMed
  12.  
    1. Nirwan P.K., Chatterjee N., Panwar R., Dudeja M., Jaggi N. Mutations in two component system (PhoPQ and PmrAB) in colistin resistant Klebsiella pneumoniae from North Indian tertiary care hospital. J. Antibiot. 2021;74:450–457. doi: 10.1038/s41429-021-00417-2. - DOI - PubMed
  13.  
    1. Veeraraghavan B., Shankar C., Venkatesan M., Rajan R., Mani D., Lal B., Prakash J.A.J., Anandan S., Pragasam A.K., Walia K., et al. Molecular characterization of colistin-resistant Klebsiella pneumoniae & its clonal relationship among Indian isolates. Indian J. Med. Res. 2019;149:199–207. doi: 10.4103/ijmr.IJMR_2087_17. - DOI - PMC - PubMed
  14.  
    1. Goel G., Hmar L., De M.S., Bhattacharya S., Chandy M. Colistin-Resistant Klebsiella pneumoniae: Report of a Cluster of 24 Cases from a New Oncology Center in Eastern India. Infect. Control Hosp. Epidemiol. 2014;35:1076–1077. doi: 10.1086/677170. - DOI - PubMed
  15.  
    1. Chew K.L., La MVan Lin R.T.P., Teo J.W.P. Colistin and Polymyxin B Susceptibility Testing for Carbapenem-Resistant and mcr-Positive Enterobacteriaceae: Comparison of Sensititre, MicroScan, Vitek 2, and Etest with Broth Microdilution. J. Clin. Microbiol. 2017;55:2609–2616. doi: 10.1128/JCM.00268-17. - DOI - PMC - PubMed
  16.  
    1. Hindler J.A., Humphries R.M. Colistin MIC Variability by Method for Contemporary Clinical Isolates of Multidrug-Resistant Gram-Negative Bacilli. J. Clin. Microbiol. 2013;51:1678–1684. doi: 10.1128/JCM.03385-12. - DOI - PMC - PubMed
  17.  
    1. Arroyo L.A., García-Curiel A., Pachón-Ibañez M.E., Llanos A.C., Ruiz M., Pachón J., Aznar J. Reliability of the E-Test Method for Detection of Colistin Resistance in Clinical Isolates of Acinetobacter baumannii. J. Clin. Microbiol. 2005;43:903–905. doi: 10.1128/JCM.43.2.903-905.2005. - DOI - PMC - PubMed
  18.  
    1. Satlin M.J., Lewis J.S., Weinstein M.P., Patel J., Humphries R.M., Kahlmeter G., Giske C.G., Turnidge J. Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing Position Statements on Polymyxin B and Colistin Clinical Breakpoints. Clin. Infect. Dis. 2020;71:E523–E529. doi: 10.1093/cid/ciaa121. - DOI - PubMed
  19.  
    1. Matuschek E., Åhman J., Webster C., Kahlmeter G. Antimicrobial susceptibility testing of colistin—Evaluation of seven commercial MIC products against standard broth microdilution for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter spp. Clin. Microbiol. Infect. 2018;24:865–870. doi: 10.1016/j.cmi.2017.11.020. - DOI - PubMed
  20.  
    1. Joanna Briggs Institute Critical-Appraisal-Tools—Critical Appraisal Tools|JBI. 2022. [(accessed on 25 May 2022)]. Available online: https://jbi.global/critical-appraisal-tools.
  21.  
    1. Munn Z., Moola S., Riitano D., Lisy K. The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence. Int. J. Health Policy Manag. 2014;3:123–128. doi: 10.15171/ijhpm.2014.71. - DOI - PMC - PubMed
  22.  
    1. Mantel N., Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. JNCI J. Natl. Cancer Inst. 1959;22:719–748. - PubMed
  23.  
    1. Bir R., Gautam H., Arif N., Chakravarti P., Verma J., Banerjee S., Tyagi S., Mohapatra S., Sood S., Dhawan B., et al. Analysis of colistin resistance in carbapenem-resistant Enterobacterales and XDR Klebsiella pneumoniae. Ther. Adv. Infect. Dis. 2022;9:20499361221080650. doi: 10.1177/20499361221080650. - DOI - PMC - PubMed
  24.  
    1. Imtiaz W., Syed Z., Rafaque Z., Andrews S.C., Dasti J.I. Analysis of Antibiotic Resistance and Virulence Traits (Genetic and Phenotypic) in Klebsiella pneumoniae Clinical Isolates from Pakistan: Identification of Significant Levels of Carbapenem and Colistin Resistance. Infect. Drug Resist. 2021;14:227–236. doi: 10.2147/IDR.S293290. - DOI - PMC - PubMed
  25.  
    1. Xiao S., Chen T., Wang H., Zeng Q., Chen Q., Yang Z., Han L., Chen E. Drug Susceptibility and Molecular Epidemiology of Klebsiella pneumoniae Bloodstream Infection in ICU Patients in Shanghai, China. Front. Med. 2021;8:754944. doi: 10.3389/fmed.2021.754944. - DOI - PMC - PubMed
  26.  
    1. Naomi-Matsuoka A., Vargas M., Ymaña B., Soza G., Pons M.J. Colistin resistance in multidrug-resistant Klebsiella pneumoniae strains at a perinatal maternal institute in Lima, Peru, 2015–2018. Rev. Peru. Med. Exp. Salud Pública. 2020;37:716–720. doi: 10.17843/rpmesp.2020.374.5422. - DOI - PubMed
  27.  
    1. Santimaleeworagun W., Thunyaharn S., Juntanawiwat P., Thongnoy N., Harindhanavudhi S., Nakeesathit S., Teschumroon S. The prevalence of colistin-resistant gram-negative bacteria isolated from hospitalized patients with bacteremia. J. Appl. Pharm. Sci. 2020;10:56–59.
  28.  
    1. Boszczowski I., Salomão M.C., Moura M.L., Freire M.P., Guimarães T., Cury A.P., Rossi F., Rizek C.F., Martins R.C.R., Costa S.F. Multidrug-resistant Klebsiella pneumoniae: Genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in Brazil. Rev. Inst. Med. Trop. Sao Paulo. 2019;61:e29. doi: 10.1590/s1678-9946201961029. - DOI - PMC - PubMed
  29.  
    1. Zhang F., Li Y., Lv Y., Zheng B., Xue F. Bacterial susceptibility in bloodstream infections: Results from China Antimicrobial Resistance Surveillance Trial (CARST) Program, 2015–2016. J. Glob. Antimicrob. Resist. 2019;17:276–282. doi: 10.1016/j.jgar.2018.12.016. - DOI - PubMed
  30.  
    1. Dong F., Zhang Y., Yao K., Lu J., Guo L., Lyu S., Yang Y., Wang Y., Zheng H., Song W., et al. Epidemiology of Carbapenem-ResistantKlebsiella pneumoniaeBloodstream Infections in a Chinese Children’s Hospital: Predominance of New Delhi Metallo-β-Lactamase-1. Microb. Drug Resist. 2018;24:154–160. doi: 10.1089/mdr.2017.0031. - DOI - PubMed
  31.  
    1. Yong D., Shin H.B., Kim Y.K., Cho J., Lee W.G., Ha G.Y., Choi T.Y., Jeong S.H., Lee K., Chong Y., et al. Increase in the Prevalence of Carbapenem-Resistant Acinetobacter Isolates and Ampicillin-Resistant Non-Typhoidal Salmonella Species in Korea: A KONSAR Study Conducted in 2011. Infect. Chemother. 2014;46:84–93. doi: 10.3947/ic.2014.46.2.84. - DOI - PMC - PubMed
  32.  
    1. Lee H., Yoon E.-J., Kim D., Jeong S.H., Won E.J., Shin J.H., Kim S.H., Shin J.H., Shin K.S., Kim Y.A., et al. Antimicrobial resistance of major clinical pathogens in South Korea, May 2016 to April 2017: First one-year report from Kor-GLASS. Eurosurveillance. 2018;23:1800047. doi: 10.2807/1560-7917.ES.2018.23.42.1800047. - DOI - PMC - PubMed
  33.  
    1. Nwabor O., Terbtothakun P., Voravuthikunchai S., Chusri S. A Bibliometric Meta-Analysis of Colistin Resistance in Klebsiella pneumoniae. Diseases. 2021;9:44. doi: 10.3390/diseases9020044. - DOI - PMC - PubMed
  34.  
    1. Juan C.-H., Chuang C., Chen C.-H., Li L., Lin Y.-T. Clinical characteristics, antimicrobial resistance and capsular types of community-acquired, healthcare-associated, and nosocomial Klebsiella pneumoniae bacteremia. Antimicrob. Resist. Infect. Control. 2019;8:1. doi: 10.1186/s13756-018-0426-x. - DOI - PMC - PubMed
  35.  
    1. Khurana S., Bhardwaj N., Kumari M., Malhotra R., Mathur P. Prevalence, etiology, and antibiotic resistance profiles of bacterial bloodstream infections in a tertiary care hospital in Northern India: A 4-year study. J. Lab. Physicians. 2018;10:426–431. doi: 10.4103/JLP.JLP_78_18. - DOI - PMC - PubMed
  36.  
    1. Saharman Y.R., Karuniawati A., Severin J.A., Verbrugh H.A. Infections and antimicrobial resistance in intensive care units in lower-middle income countries: A scoping review. Antimicrob. Resist. Infect. Control. 2021;10:22. doi: 10.1186/s13756-020-00871-x. - DOI - PMC - PubMed
  37.  
    1. Kadri S.S., Hohmann S.F., Orav E.J., Bonne S.L., Moffa M.A., Timpone J.G., Strich J.R., Palmore T., Christopher K.B., Varughese C., et al. Tracking colistin-treated patients to monitor the incidence and outcome of carbapenem-resistant Gram-negative infections. Clin. Infect. Dis. 2015;60:79–87. doi: 10.1093/cid/ciu741. - DOI - PMC - PubMed
  38.  
    1. Falagas M.E., Kasiakou S.K., Saravolatz L.D. Colistin: The Revival of Polymyxins for the Management of Multidrug-Resistant Gram-Negative Bacterial Infections. Clin. Infect. Dis. 2005;40:1333–1341. doi: 10.1086/429323. - DOI - PubMed
  39.  
    1. Karki D., Dhungel B., Bhandari S., Kunwar A., Joshi P.R., Shrestha B., Rijal K.R., Ghimire P., Banjara M.R. Antibiotic resistance and detection of plasmid mediated colistin resistance mcr-1 gene among Escherichia coli and Klebsiella pneumoniae isolated from clinical samples. Gut Pathog. 2021;13:45. doi: 10.1186/s13099-021-00441-5. - DOI - PMC - PubMed
  40.  
    1. Arteaga-Livias K., Pinzas-Acosta K., Perez-Abad L., Panduro-Correa V., Rabaan A.A., Pecho-Silva S., Dámaso-Mata B. A multidrug-resistant Klebsiella pneumoniae outbreak in a Peruvian hospital: Another threat from the COVID-19 pandemic. Infect. Control Hosp. Epidemiol. 2022;43:267–268. doi: 10.1017/ice.2020.1401. - DOI - PMC - PubMed
  41.  
    1. Sader H.S., Mendes R.E., Streit J.M., Carvalhaes C.G., Castanheira M. Antimicrobial susceptibility of Gram-negative bacteria from intensive care unit and non-intensive care unit patients from United States hospitals (2018–2020) Diagn. Microbiol. Infect. Dis. 2022;102:115557. doi: 10.1016/j.diagmicrobio.2021.115557. - DOI - PubMed
  42.  
    1. Ibrahim M.E. High antimicrobial resistant rates among Gram-negative pathogens in intensive care units: A retrospective study at a tertiary care hospital in Southwest Saudi Arabia. Saudi Med. J. 2018;39:1035. doi: 10.15537/smj.2018.10.22944. - DOI - PMC - PubMed
  43.  
    1. Sommerstein R., Damonti L., Marschall J., Harbarth S., Gasser M., Kronenberg A., Buetti N. Distribution of pathogens and antimicrobial resistance in ICU-bloodstream infections during hospitalization: A nationwide surveillance study. Sci. Rep. 2021;11:16876. doi: 10.1038/s41598-021-95873-z. - DOI - PMC - PubMed
  44.  
    1. Raineri E., Crema L., Zoppo S.D., Acquarolo A., Pan A., Carnevale G., Albertario F., Candiani A. Rotation of antimicrobial therapy in the intensive care unit: Impact on incidence of ventilator-associated pneumonia caused by antibiotic-resistant Gram-negative bacteria. Eur. J. Clin. Microbiol. Infect. Dis. 2010;29:1015–1024. doi: 10.1007/s10096-010-0964-5. - DOI - PubMed
  45.  
    1. Petrosillo N., Taglietti F., Granata G. Treatment Options for Colistin Resistant Klebsiella pneumoniae: Present and Future. J. Clin. Med. 2019;8:934. doi: 10.3390/jcm8070934. - DOI - PMC - PubMed
  46.  
    1. Koşar I., Dinc G., Eren E., Aykemat Y., Doganay M. Investigation of double carbapenem efficiency in experimental sepsis of colistin resistant Klebsiella pneumoniae. North. Clin. Istanb. 2020;8:113–118. doi: 10.14744/nci.2020.14238. - DOI - PMC - PubMed
  47.  
    1. Docobo-Pérez F., Nordmann P., Dominguez-Herrera J., López-Rojas R., Smani Y., Poirel L., Pachón J. Efficacies of colistin and tigecycline in mice with experimental pneumonia due to NDM-1-producing strains of Klebsiella pneumoniae and Escherichia coli. Int. J. Antimicrob. Agents. 2012;39:251–254. doi: 10.1016/j.ijantimicag.2011.10.012. - DOI - PubMed
  48.  
    1. Shein A.M.S., Wannigama D.L., Higgins P.G., Hurst C., Abe S., Hongsing P., Chantaravisoot N., Saethang T., Luk-In S., Liao T., et al. Novel colistin-EDTA combination for successful eradication of colistin-resistant Klebsiella pneumoniae catheter-related biofilm infections. Sci. Rep. 2021;11:21676. doi: 10.1038/s41598-021-01052-5. - DOI - PMC - PubMed

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