Colistin resistance among the Gram-negative nosocomial pathogens in India: A systematic review and meta-analysis

Background The rapid rise of nosocomial infections and the growing ineffectiveness of frontline antibiotics against Gram-negative bacteria (GNB) have put the healthcare sector under unprecedented stress. In this scenario, colistin, an antibiotic of the polymyxin class, has become the last resort treatment option. The unrestricted use of colistin in the preceding decades has led to the emergence of colistin-resistant (ColR) bacterial strains. Unfortunately, comprehensive data on the prevalence of ColR nosocomial pathogens in India are lacking. This study was conducted to address this information gap and to determine the prevalence of ColR among the nosocomial GNB species in India. Methods A systematic review and meta-analysis were conducted to determine the prevalence of ColR among the nosocomial GNB species in India and their geographical distribution. A systematic search of the online databases was performed and eligible studies meeting the inclusion criteria were used for qualitative synthesis. The combined event rate and 95% confidence interval were estimated using forest plot with a random-effect model. Cochrane Q statistics and I2 statistics were used to detect possible heterogeneity. Results From a total of 1865 retrieved records from 4 databases, 36 studies were included in the study. Among the most common nosocomial pathogens , K. pneumoniae showed a rate of ColR at 17.4%, followed by P. aeruginosa (14.1%), E. coli (12.3%), and A. baumannii (12.2%). Interestingly, our analysis revealed that E. cloacae has the highest rate of ColR at 28.5%. Conclusions The level of resistance displayed by K. pneumoniae , P. aeruginosa , and to a lesser extent, E. coli and A. baumannii in the Indian subcontinent poses a challenge for public health management. Though prevalence may differ among regions and over time, continued surveillance, and efforts to curb the spread of resistance are crucial to ensure the continued effectiveness of this critical antibiotic. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work is supported by the funds received from the Science and Technology Department, Govt. of Odisha (Grant no. ST-BT-MISC-0005-2023-2463/ST, dt. 23-05-2023). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.