Global distribution, genotypes and prevalent sequence types of colistin-resistant Klebsiella pneumoniae isolated from clinical samples; A systematic review

In the last decade, a high number of Klebsiella pneumoniae (K. pneumoniae) with carbapenem resistance emerged, making treatment of this infection difficult or even impossible. Colistin is the last option for the treatment of these bacteria, and so the emergence of resistance to it can raise concerns. As a comprehensive systematic review, the current study aimed to evaluate the prevalence and dissemination of colistin resistance genes in human clinical isolates of K. pneumoniae worldwide. Main electronic databases, including Medline (via PubMed), EMBASE, and Web of Science, were searched and reviewed for original research articles. All studies which reported the prevalence and type of colistin resistance in clinical isolates of K. pneumoniae published between 1987 and 2020 were selected for further evaluation. 279 relevant articles were included in the study after searching and screening processes. More than 75 % of these studies were published from 2013 to 2020. The overall global prevalence of colistin-resistant K. pneumoniae (CoRKp) strains was 11.64 %. Oceania and then America had the highest levels of CoRKp. The prevalence of mcr-producing CoRKp in Asia, Europe, America, and Africa was 84.11 %, 8.41 %, 4.67 %, and 2.80 %, respectively. The significant increase in CoRKp strains in recent years in various parts of the world, especially in Asia, requires more attention by health care providers, physicians, and microbiologists. •Prevalence of colistin-resistant Klebsiella pneumoniae (CoRKp) isolated from clinical samples around the world•Distribution of mcr-producing K. pneumoniae isolated from clinical samples around the world•Distribution of mcr variants among CoRKp strains isolated from clinical samples around the world•Distribution of sequence types (STs) among CoRKp isolates around the world•Most prevalent STs among mcr-producing CoRKp strains around the world