A Bibliometric Meta-Analysis of Colistin Resistance in Klebsiella pneumoniae

Nwabor, Ozioma Forstinus; Terbtothakun, Pawarisa; Voravuthikunchai, Supayang Piyawan; Chusri, Sarunyou

doi:10.3390/diseases9020044

Cited by 4 publications

(7 citation statements)

References 116 publications

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“…Multidrug-resistant gram-negative bacteria (MDR) threaten public health globally [ 33 ]. Among gram-negative bacteria, Klebsiella pneumoniae is one of the most common causes of healthcare-associated infections (HALs) [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…In addition, a pressing need has arisen to control and eradicate K. pneumoniae, exhibiting resistance towards several antibiotics including colistin. 107,108 Antibiotic-resistant K. pneumoniae has become a serious problem in clinics and requires immediate measures. 109 Phages have the potential to replace antibiotics and have recently attracted much scientific and public attention for treating MDR bacterial infections.…”

Section: Klebsiella Pneumoniaementioning

confidence: 99%

“…The Center for Disease Control and Prevention (CDC) in 2013 and the WHO 106 have listed Enterobacteriaceae with carbapenem‐ or cephalosporin‐resistant profiles (including K. pneumoniae ) among critical pathogens requiring urgent action. In addition, a pressing need has arisen to control and eradicate K. pneumoniae , exhibiting resistance towards several antibiotics including colistin 107,108 . Antibiotic‐resistant K. pneumoniae has become a serious problem in clinics and requires immediate measures 109 …”

Section: Crispr‐cas9‐based Phage Design For Controlling Bacteriamentioning

confidence: 99%

Phage engineering and phage‐assisted CRISPR‐Cas delivery to combat multidrug‐resistant pathogens

Khambhati

Bhattacharjee

Gohil

et al. 2022

Bioengineering & Transla Med

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Antibiotic resistance ranks among the top threats to humanity. Due to the frequent use of antibiotics, society is facing a high prevalence of multidrug resistant pathogens, which have managed to evolve mechanisms that help them evade the last line of therapeutics. An alternative to antibiotics could involve the use of bacteriophages (phages), which are the natural predators of bacterial cells. In earlier times, phages were implemented as therapeutic agents for a century but were mainly replaced with antibiotics, and considering the menace of antimicrobial resistance, it might again become of interest due to the increasing threat of antibiotic resistance among pathogens. The current understanding of phage biology and clustered regularly interspaced short palindromic repeats (CRISPR) assisted phage genome engineering techniques have facilitated to generate phage variants with unique therapeutic values. In this review, we briefly explain strategies to engineer bacteriophages. Next, we highlight the literature supporting CRISPR-Cas9-assisted phage engineering for effective and more specific targeting of bacterial pathogens. Lastly, we discuss techniques that either help to increase the fitness, specificity, or lytic ability of bacteriophages to control an infection.

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“…The modifications of the PmrA/PmrB and PhoP/PhoQ two-component systems and the inactivation of the mgrB gene (a regulator of the PhoP/PhoQ system) are known to be majorly involved in colistin resistance via LPS modification [8]. Among these, mgrB mutations seem to be common and increasingly reported in Klebsiella pneumoniae as compared to other Enterobacterales [9][10][11][12]. In K. pneumoniae, mgrB mutations which involve substitution, disruption, or inactivation have been identified as playing a prominent role in mediating colistin resistance [8].…”

Section: Introductionmentioning

confidence: 99%

“…Many studies have focused on the genetic causes of mgrB inactivation, but there are limited studies focused on the physical changes of the resistant membranes [12]. Thus, the present review intends to outline the current understanding of mgrB-associated membrane changes among the K. pneumoniae mutant, which may provide insights for future studies in membrane-targeting antimicrobial research.…”

Section: Introductionmentioning

confidence: 99%

MgrB Mutations and Altered Cell Permeability in Colistin Resistance in Klebsiella pneumoniae

Yap

Cheng

Chang

et al. 2022

Cells

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There has been a resurgence in the clinical use of polymyxin antibiotics such as colistin due to the limited treatment options for infections caused by carbapenem-resistant Enterobacterales (CRE). However, this last-resort antibiotic is currently confronted with challenges which include the emergence of chromosomal and plasmid-borne colistin resistance. Colistin resistance in Klebsiella pneumoniae is commonly caused by the mutations in the chromosomal gene mgrB. MgrB spans the inner membrane and negatively regulates PhoP phosphorylation, which is essential for bacterial outer membrane lipid biosynthesis. The present review intends to draw attention to the role of mgrB chromosomal mutations in membrane permeability in K. pneumoniae that confer colistin resistance. With growing concern regarding the global emergence of colistin resistance, deciphering physical changes of the resistant membrane mediated by mgrB inactivation may provide new insights for the discovery of novel antimicrobials that are highly effective at membrane penetration, in addition to finding out how this can help in alleviating the resistance situation.

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A Bibliometric Meta-Analysis of Colistin Resistance in Klebsiella pneumoniae

Cited by 4 publications

References 116 publications

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

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

Phage engineering and phage‐assisted CRISPR‐Cas delivery to combat multidrug‐resistant pathogens

MgrB Mutations and Altered Cell Permeability in Colistin Resistance in Klebsiella pneumoniae

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