Prevalence of mutated colistin-resistant 'Klebsiella pneumoniae': A systematic review and meta-analysis

The emergence of genetic mutations in chromosomal genes and the transmissible plasmidmediated colistin resistance gene may have helped in the spread of colistin resistance among various 'Klebsiella pneumoniae' ('K. pneumoniae') isolates and other different bacteria. In this study, the prevalence of mutated colistin-resistant 'K. pneumoniae' isolates was studied globally using a systematic review and meta-analysis approach. A systematic search was conducted in databases including PubMed, ScienceDirect, Scopus and Google Scholar. The pooled prevalence of mutated colistin resistance in 'K. pneumoniae' isolates was analyzed using Comprehensive Meta-Analysis Software (CMA). A total of 50 articles were included in this study. The pooled prevalence of mutated colistin resistance in 'K. pneumoniae' was estimated at 75.4% (95% CI = 67.2-82.1) at high heterogeneity ('I2' = 81.742%, 'p'-value < 0.001). Meanwhile, the results of the subgroup analysis demonstrated the highest prevalence in Saudi Arabia with 97.9% (95% CI = 74.1-99.9%) and Egypt, with 4.5% (95% CI = 0.6-26.1%), had the lowest. The majority of mutations could be observed in the 'mgrB' gene (88%), 'pmrB' gene (54%) and 'phoQ' gene (44%). The current study showed a high prevalence of the mutation of colistin resistance genes in K. pneumoniae. Therefore, it is recommended that regular monitoring be performed to control the spread of colistin resistance.