Prevalence of polymyxin resistant bacterial strains in India: a systematic review and meta-analysis

Abstract

IntroductionPolymyxins, the cationic lipopeptide antibiotics, are considered to be the last line of therapeutics against the multi-drug resistant (MDR) pathogenic Gram-negative bacteria. Unfortunately, the rising cases of polymyxin-resistant strains from across the globe have adversely impacted the available treatment options. While the molecular mechanisms responsible for developing polymyxin resistance (PolR) are understood to a great extent, the prevalence of PolRstrains in India is not investigated systematically.MethodFor this study, a systematic search for relevant articles was performed in the relevant databases for the period January 2015 to August 2023. A meta-analysis was performed using the comprehensive meta-analysis software (V.3) to determine the overall prevalence of PolRbacterial strains in India. Publication biases were assessed using funnel plots and Egger’s regression analysis.ResultConsidering a total of 79 studies selected based on the relevant inclusion and exclusion criteria, the present meta-analysis found the rate of PolRbacteria in India to be at 12.7%, which is higher than the global average. Among the Indian States, Tamil Nadu topped with the highest prevalence of PolRat 23%. Investigating the contribution of the mobile colistin resistance (mcr) genes, it was observed that among the PolRstrains, 8.6 % weremcrpositive.ConclusionThemcr-positive strains reported from India could be an underestimation of the actual numbers due to the non-inclusion ofmcrscreening in many previous studies. Our study provides insight into the state of the PolRsituation in India, which may be useful to develop a monitoring strategy to contain the spread of such strains and preserve the potency of the polymyxins.