Skip to main content
Download PDF
  • Systematic Review
  • Open access
  • Published:

Prevalence of colistin-resistant Enterobacteriaceae isolated from clinical samples in Africa: a systematic review and meta-analysis

BMC Infectious Diseases volume 25, Article number: 437 (2025) Cite this article

Abstract

Background

Antimicrobial resistance among Enterobacteriaceae poses a significant global threat, particularly in developing countries. Colistin, a critical last-resort treatment for infections caused by carbapenem-resistant and multidrug-resistant strains, is increasingly facing resistance due to inappropriate use of colistin and the spread of plasmid-mediated resistance genes. Despite the significance of this issue, comprehensive and updated data on colistin resistance in Africa is lacking. Thus, the current study was aimed to determine the pooled prevalence of colistin-resistant Enterobacteriaceae in Africa.

Methods

A systematic search was conducted across PubMed, Scopus, ScienceDirect, and Google Scholar to identify relevant studies. Forty-one studies reporting on the prevalence of colistin resistance in Enterobacteriaceae isolates from clinical specimens in Africa were included in the analysis. Stata 17 software was used to calculate the pooled prevalence of colistin resistance, employing a random-effects model to determine the event rate of resistance. Heterogeneity across studies was assessed using the I2 statistic, and publication bias was evaluated using Egger’s test. Subgroup analyses were performed to address any identified heterogeneity.

Results

This systematic review analyzed the colistin resistance profile of 9,636 Enterobacteriaceae isolates. The overall pooled prevalence of colistin resistance was 26.74% (95% CI: 16.68–36.80). Subgroup analysis by country revealed significant variability in resistance rates, ranging from 0.5% in Djibouti to 50.95% in South Africa. Species-specific prevalence of colistin resistance was as follows: K. pneumoniae 28.8% (95% CI: 16.64%-41.05%), E. coli 24.5% (95% CI: 11.68%-37.3%), Proteus spp. 50.0% (95% CI: 6.0%-106.03%), and Enterobacter spp. 1.22% (95% CI: -0.5%-3.03%).

Analysis based on AST methods revealed significant differences in colistin resistance rates (p = 0.001). The resistance rates varied between 12.60% for the disk diffusion method and 28.0% for the broth microdilution method. Additionally, a subgroup analysis of clinical specimens showed significant variation (p < 0.001) in colistin resistance. Stool specimen isolates had the highest resistance rate at 42.0%, while blood specimen isolates had a much lower resistance rate of 3.58%.

Conclusions

Colistin resistance in Enterobacteriaceae is notably high in Africa, with significant variation across countries. This underscores the urgent need for effective antimicrobial stewardship, improved surveillance, and the development of new antibiotics.

Peer Review reports

Introduction

Antimicrobial resistance (AMR) is a growing global public health threat, particularly among Gram-negative bacteria (GNB), which contribute significantly to disease burden and mortality. In 2019, AMR directly caused an estimated 1.27 million deaths, and an additional 5 million deaths were associated to it [1]. A major concern is the rise of drug-resistant infections, especially those caused by antibiotic-resistant bacteria acquired in hospitals, which are becoming more common in developing countries [2,3,4].

The Enterobacteriaceae family includes important pathogens such as Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), Proteus spp., and Enterobacter spp. These bacteria are responsible for nearly 60% of hospital-acquired infections and also cause severe community-acquired infections [5]. The Enterobacteriaceae causes a range of infections, including urinary tract infections, bloodstream infections, and gastrointestinal illnesses [6]. A big issue with Enterobacteriaceae is the rising of antimicrobial resistance [7]. Many of these bacterial strains are resistant to several antibiotics, including the latest ones like β-lactams and carbapenems. This makes treatment more challenging, especially in resource limiting countries [8, 9].

To fight multidrug-resistant (MDR) strains, healthcare systems have increasingly turned to last-line antibiotics like colistin, which is used to treat severe infections caused by MDR Gram-negative bacteria (GNB) [10]. Colistin is a polycationic antibiotic with broad-spectrum bactericidal activity. It targets the lipopolysaccharides in the cell walls of GNB, disrupting their outer membrane and causing the bacteria to break apart and die [11]. Colistin was initially restricted to veterinary medicine due to its nephrotoxicity and neurotoxicity [12]. However, the rise of MDR and carbapenem-resistant Enterobacteriaceae has led to its renewed use in humans [13]. Unfortunately, the increasing resistance to this critical antibiotic is becoming a global challenge, as it is becoming less effective in treating resistant infections, making patient care even more difficult [14].

The increasing prevalence of colistin-resistant infections is primarily driven by alterations in the bacterial cell wall [15] and the dissemination of plasmid-mediated colistin resistance genes (mcr genes), including mcr-1 through mcr-10 [16]. A single global review report indicated that colistin resistance among E. coli isolates in Africa was 2.3% [17]. Knowing and monitoring colistin-resistant Enterobacteriaceae isolates is essential for developing effective treatment and intervention strategies to prevent their spread in various environments, including hospitals and community settings. However, there is a significant lack of comprehensive data on colistin resistance in clinical isolates of Enterobacteriaceae in Africa. This gap in knowledge makes it difficult to fully understand the extent of colistin resistance across the continent. As a result, efforts to combat the spread of resistant bacteria are hindered, potentially worsening the challenges that healthcare systems already face. To address this issue, there is an urgent need for detailed surveillance and research initiatives to guide evidence-based strategies for controlling colistin-resistance in Africa. Hence, we conducted this systematic review and meta-analysis study to highlight the pooled prevalence of colistin resistance among clinical isolates of Enterobacteriaceae in Africa.

Methods

Protocol

This systematic review and meta-analysis adhere strictly to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [18] (Fig. 1).

Fig. 1
figure 1

PRISMA flow diagram showed the results of the search and reasons for exclusion

Full size image

Literature search

A systematic literature search was conducted from November 15, 2023, to January 15, 2024, to identify articles reporting colistin resistance from 2010 until December 2023. The search utilized four well-known biomedical repositories: PubMed, Scopus, Science Direct, and the Google Scholar search engine. Medical Subject Headings (MeSH) and other relevant keywords were combined using Boolean operators “AND” and “OR,” such as [“prevalence” OR “epidemiology,” “colistin” OR “polymyxin,” OR “colistin-resistant” OR “Enterobacteriaceae” OR “Gram-negative” AND Africa]. Each African country was also paired with search keywords to retrieve relevant articles. The complete search strategy and search strings used in the databases are detailed in the supplementary file (Supplementary file, Table S1).

Eligible criteria

To identify eligible articles, we applied predetermined inclusion and exclusion criteria. Inclusion criteria were: (a) articles published in English; (b) original research in peer-reviewed journals; (c) studies reporting the prevalence of colistin resistance in Enterobacteriaceae isolates; (d) research conducted on clinical samples; (e) studies conducted in Africa and (f) studies published between January 1, 2010, and December 31, 2023,(g) Researches done by broth microdilution, VITEK2, disk diffusion methods were included. Exclusion criteria included: (a) studies not reporting or lacking clear prevalence data on colistin resistance in clinical Enterobacteriaceae isolates; (b) unrelated studies; (c) studies in languages other than English; (d) publications outside the specified time frame; (e) studies with non-human or unclear specimen origins; and (f) letters, editorials, conference papers, and systematic reviews or meta-analyses. Currently, available tests for colistin resistance are molecular or phenotypic. As recommended jointly by the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Test (EUCAST), broth microdilution (BMD) method is now the only gold standard for determining colistin minimum inhibition concentration (MIC) values [19].

Study selection

Two reviewers (Y.G. and M.A.R.) independently conducted the literature search, and the retrieved articles were imported into EndNote version 20 (Thomson Reuters, New York) for reference management, where duplicates were removed. A total of 6,979 non-duplicate, potentially relevant studies were identified from the databases and Google Scholar. Four reviewers (Y.G., M.A.R., Z.A., and A.S.) independently screened the titles, abstracts, and full-text assessment.

Quality assessments

The included studies were assessed for quality using the Joanna Briggs Institute’s (JBI) critical appraisal tool for prevalence data [20]. Two independent reviewers (Y.G. and M.A.R.) critically appraised each study. All the included studies in the analysis had a score of 50% or higher on the checklist, indicating high quality (Supplementary file, Table S2).

Data extraction

Three reviewers (Y.G., Z.A., and A.S.) independently extracted relevant data from the included articles using a standardized data extraction form in Microsoft Excel 2013. Extracted data included: country, first author’s surname, year of publication, Type of Antimicrobial susceptibility test (AST) methods (BMD, Disk diffusion and VITEK2), and sample size, types of clinical samples (e.g., urine, blood, sputum, endotracheal aspirate, and swabs), bacterial species isolated, MDR isolates, and colistin susceptibility profiles. Any disagreements during data extraction were resolved through discussion and consensus. If consensus could not be reached, other investigators (M.A.R. and S.T.) were consulted.

Data analysis

The data extracted using Microsoft Excel 2013 were exported to STATA 17.0 software (StataCorp, Texas, USA) for analysis of the pooled prevalence of colistin resistance among clinical isolates. Random effect model was used to compute the pooled prevalence and the inverse variance (I2) test was performed to assess heterogeneity across studies, with I2 values interpreted as follows: 0% (no heterogeneity), 0–25% (low heterogeneity), 25–50% (medium heterogeneity), and > 75% (high heterogeneity) [21]. To calculate the pooled prevalence of colistin resistance, a continuity correction was made for zero and one hundred percent colistin resistance values reported from certain studies, to circumvent the zero standard error during the pooled meta-analysis [22]. Subgroup analysis was performed for specific categories such as year, country, AST methods used, species and specimen type to explore sources of heterogeneity among the studies. Egger’s test was used to detect potential publication bias, with a significance value, p < 0.05 at 95% CI. Additionally, a trim-and-fill analysis was conducted to adjust for any potential bias.

Results

Searching results

A total of 6,979 non-duplicate, potentially relevant studies were identified and retrieved from the databases. After screening the titles and abstracts, 6,379 articles were considered irrelevant and excluded, and the remaining 600 full-text articles were assessed for eligibility; only 41 articles met the inclusion criteria and were included in the final meta-analysis (Fig. 1).

A descriptive summary of studies included

This systematic review included 41 studies [3, 23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62] from 19 countries reporting the colistin resistance profile of Enterobacteriaceae. Specifically, 30 studies focused on K. pneumoniae, 26 on E. coli, 10 on Enterobacter species, and 4 on Proteus species. The majority of studies were from Egypt (n = 12), Nigeria (n = 5), Tunisia (n = 4), South Africa (n = 4), and Algeria (n = 2). The remaining studies came from Morocco, Rwanda, Democratic Republic of the Congo, Djibouti, Ethiopia, Sudan, Kenya, Mali, Senegal, Somalia, Libya, Ghana, Burkina Faso, and Mozambique (each n = 1) (Table 1). All studies included in this final quantitative review employed a cross-sectional study design and most of the articles used BMD AST method.

Table 1 Summary of studies included on colistin-resistant Enterobacteriaceae species in Africa
Full size table

The review included 41 studies, covering a total of 9,636 Enterobacteriaceae isolates. Among these, 1,624 were MDR and 581 were resistant to colistin, collected from various clinical specimens. There were approximately 7,420 non-MDR isolates, with 282 being colistin-resistant. Additionally, 1,192 MDR isolates were identified, of which 229 were colistin-resistant. In the current study, a total of 5,021 K. pneumoniae isolates were identified, of which 915 were MDR and 350 were resistant to colistin. Additionally, 4,442 E. coli isolates were reported, with 685 being MDR and 215 resistant to colistin. Among the MDR isolates, K. pneumoniae was the most prevalent (915 isolates), with 160 of these showing both MDR and colistin resistance. E. coli was also the second most common MDR isolate (685 isolates), with 78 of them showing both MDR and colistin resistance (Table 1).

Meta-analysis

Prevalence of colistin-resistant Enterobacteriaceae

The initial pooled prevalence of colistin-resistant Enterobacteriaceae (K. pneumoniae, E. coli, Enterobacter, and Proteus spp.) was estimated at 26.74% (95% CI: 16.68–36.80) based on the included studies. However, significant heterogeneity was observed (I2 = 99.95%, P < 0.001) (Fig. 2). Additionally, the funnel plot (Supplementary file, Figure S1) and Egger’s test (P = 0.0228) indicated the presence of publication bias. To address this, a trim-and-fill analysis was performed, resulting in the imputation of six studies. After adjusting for publication bias, the final pooled prevalence of colistin resistance was recalculated at 32.31% (95% CI: 22.93–41.69%) (Supplementary file, Table S3).

Fig. 2
figure 2

Forest plot showing the pooled prevalence of colistin-resistant Enterobacteriaceae in Africa

Full size image

Subgroup-analysis

Subgroup analyses were conducted based on year, country, AST methods, species, and specimen type to identify potential sources of variation. The analysis revealed significant differences in colistin resistance across these factors. Country-based analysis showed notable variations in resistance levels. South Africa had the highest colistin resistance at 50.95% (95% CI: 14.10–87.80), followed by Nigeria at 36.18% (95% CI: 4.49–67.87). In contrast, Egypt had a lower prevalence of colistin resistance at 19.93% (95% CI: 5.10–34.77). The high heterogeneity observed across these countries (I2 = 97% −99.87%) highlighted the substantial variation in resistance.

The type of AST method used revealed notable differences in prevalence of colistin resistance. Studies using the BMD method found a resistance rate of 27.96% (95% CI: 16.40–39.52) and the VITEK2 method showed a prevalence of 18.83% (95% CI: −0.96–38.62). In contrast, the disk diffusion method reported a lower resistance rate of 12.59% (95% CI: 0.74–24.43). Additionally, there was considerable heterogeneity across all methods, with I2 values ranging from 87.31% to 99.97%.

Species wise analysis showed that, colistin resistance was highest in Proteus spp. (50.02%, 95% CI: 17.25–33.14), followed by K. pneumoniae (28.84%, 95% CI: 16.64–41.50) and E. coli (24.50%, 95% CI: 11.68–37.31). Enterobacter spp. showed very low resistance (1.22%, 95% CI: −0.59–3.03) with no significant heterogeneity (I2 = 0%) (Table 2). Subgroup analysis of clinical specimens also showed significant variation (p < 0.001). According to the analysis, stool specimen isolates had the highest colistin resistance at 42.0% (95% CI: 0.41%−83.36%), while blood specimen isolates had a lower resistance rate of 3.58% (95% CI: −2.03%−9.2%). The prevalence of colistin resistance in mixed clinical isolates was steady at 25.23% (95% CI: 12.90%−37.62%). (Table 2).

Table 2 Subgroup analysis for colistin-resistant Enterobacteriaceae
Full size table

Pooled prevalence of colistin resistance among each Enterobacteriaceae species

In this meta-analysis, the pooled prevalence of colistin-resistant K. pneumoniae was 28.8% (95% CI: 16.64–41.05%) (Fig. 3). However, the Egger’s test indicated the presence of publication bias, prompting a trim-and-fill analysis that adjusted the prevalence to 32.1% (95% CI: 20.48–43.73%) (Supplementary file, Table S4). Similarly, the pooled prevalence of colistin-resistant E. coli was found to be 24.5% (95% CI: 11.68–37.3%) (Fig. 4), but publication bias was also detected (Supplementary file, Figure S3), leading to a revised prevalence of 26.5% (95% CI: 14.34–38.74%) after trim-and-fill analysis (Supplementary file, Table S5). For Enterobacter species, the pooled prevalence of colistin resistance was considerably lower at 1.22% (95% CI: –3.03%) (Fig. 5), with no detected heterogeneity or publication bias (Supplementary file, Figure S4). In contrast, Proteus species exhibited the highest pooled prevalence of colistin resistance at 50.0% (95% CI: 6.0–106.03%) (Fig. 6). However, this analysis revealed high levels of heterogeneity and publication bias, after imputing one additional study to account for potential publication bias, the prevalence increased to 66.58% (Supplementary file, Figure S5 & Table S6).

Fig. 3
figure 3

Forest plot illustrating the pooled prevalence of colistin resistance among Klebsiella pneumoniae isolates

Full size image
Fig. 4
figure 4

Forest plot for pooled prevalence of colistin resistance among E. coli isolates in Africa from 2010 to 2023

Full size image
Fig. 5
figure 5

Forest plot for pooled prevalence of colistin resistance among Enterobacter species isolates in Africa from 2010 to 2023

Full size image
Fig. 6
figure 6

Forest plot for pooled prevalence of colistin resistance among Proteus spp. isolates in Africa from 2010 to 2023 G.C

Full size image

Discussion

The widespread emergence of MDR Enterobacteriaceae bacteria has raised significant concerns, driving the increased use of colistin as a last-resort antibiotic. However, the growing prevalence of MDR bacterial infections has led to the rising threat of colistin-resistant Enterobacteriaceae [63]. This resistance, primarily linked to the mobile colistin resistance (mcr) gene, including mcr-1 through mcr-10, is spreading rapidly worldwide, intensifying the challenges in managing infections caused by these pathogens. The development of colistin-resistant strains is particularly problematic, as it significantly limits treatment options [64].

The present study documented a total of 9,636 Enterobacteriaceae isolates, with K. pneumoniae being the most predominant (5,021 isolates) followed by E. coli (4,442 isolates).The study identified 5,021 K. pneumoniae isolates, of which 915 were MDR and 350 resistant to colistin. Additionally, 4,442 E. coli isolates were reported, with 685 MDR and 215 colistin-resistant. Among the MDR isolates, K. pneumoniae was most common (915 isolates), with 160 showing both MDR and colistin resistance, while E. coli followed with 685 MDR isolates, 78 of which were also resistant to colistin. In our study, we highlights the significant presence of both MDR and colistin resistance in K. pneumoniae and E. coli, with K. pneumoniae being more commonly associated with both types of resistance. The impact of concomitant resistance in K. pneumoniae and E. coli significantly affects treatment options, patient outcomes, infection control, and public health [65].

The pooled prevalence of colistin resistance among Enterobacteriaceae in the current review was 26.74%, which was higher than the global prevalence of 9.1% [66], Iran (0.8%) [67], Spain (0.7%) [68] and lower than the study conducted in Gaza, it was 41% among tested clinical isolates [69]. This might be due to different drug susceptibility testing methods used, different geographical locations, social-economic differences, and also the differences in healthcare systems, including antimicrobial resistance control policies.

Klebsiella pneumoniae is one of the major hospital-acquired bacteria, which is associated with causing life-threatening infections like pneumonia and bacteremia [70]. Currently, K. pneumoniae resistance to several antibiotics has increased drastically, and the dissemination of carbapenems-resistant K. pneumoniae isolates has been reported globally [71]. In the current review, the pooled rate of colistin resistance for K. pneumoniae was 28.8%. Our finding indicates, it was higher than the global pooled prevalence of colistin resistance at 3.1% [72], while it was consistent with study reports in Iran at 16.9% [73], Turkey (27.5%), and United Arab Emirates (31.4%) [73]. However, the finding was lower than the study reported in Greece (61%) [74], Saudi Arabia (75.4%) [75], and Hungary (88.9%) [76].

The pooled rate of colistin resistance for E. coli was 24.50%. E. coli is the most common Gram-negative bacteria in the human gastrointestinal tract and lacks virulence in this setting. However, when found outside of the intestinal tract, E. coli can cause urinary tract infections (UTI), pneumonia, bacteremia, and peritonitis [77]. The present study result reveals it is higher than the global pooled prevalence of colistin resistance 3.44% [66] and Asia at 3.64% [17], America (0.48%), Europe (0.62%), Russia (0.01%) [17] as well as previously studied data in Africa (2.27%) [17] but it was lower than reported from Burkina Faso (61.3%) [51], Ireland, Finland, Portugal, and Austria (100%), and the Netherlands (85.71%) [17]. Concomitant MDR K. pneumoniae and E. coli infections present a particularly complex and challenging clinical scenario, as both pathogens are commonly associated with serious infections and are increasingly resistant to multiple classes of antibiotics [78].

Colistin resistance prevalence in proteus was 50.02%, which was the highest in our result compared to other bacteria. This finding is comparable to the study reported in Gaza (63.2%) [69]. Proteus spp. are known to exhibit intrinsic resistance to certain antibiotics. This resistance is part of their natural characteristics and is due to several mechanisms: such as Beta-lactamase production, Efflux pumps, Altered porin channels, and intrinsic low permeability. Hence, these mechanisms contribute to its resistance to being high. Concomitant MDR Proteus spp. also makes the treatment of infections caused by this strain much more challenging, as fewer antibiotics would be effective [14].

The country-based analysis revealed notable differences in resistance levels. South Africa exhibited the highest colistin resistance at 50.95% (95% CI: 14.10–87.80), followed by Nigeria at 36.18% (95% CI: 4.49–67.87). In contrast, Egypt had a significantly lower of prevalence of colistin resistance at 19.93% (95% CI: 5.10–34.77). The substantial variation in resistance across these countries was highlighted by the high heterogeneity observed (I2 > 97%). The differences in colistin resistance among such countries could be attributed to several factors, including differences in antimicrobial usage, healthcare infrastructure, surveillance systems, methodological difference, and regional microbial characteristics [79].

The analysis based on types of AST method revealed notable differences in resistance prevalence. Studies using the BMD method found a resistance rate of 27.96% (95% CI: 16.40–39.52) and the VITEK2 method showed a prevalence of 18.83% (95% CI: −0.96–38.62). In contrast, the disk diffusion method reported a lower resistance rate of 12.59% (95% CI: 0.74–24.43). The minimum inhibitory concentration (MIC) method for determining colistin resistance in Enterobacteriaceae is primarily conducted using BMD, which is recommended by both EUCAST and CLSI as the reference method. This method is crucial for accurately assessing colistin susceptibility due to the challenges associated with other testing methods. It may provide a more sensitive and precise result, capturing lower levels of resistance that other methods might miss. This could explain the higher resistance prevalence of 27.96% observed in studies using BMD method [80]. The VITEK2 system is an automated method that uses a combination of biochemical tests and a special reagent to determine antimicrobial susceptibility. While the VITEK2 method is generally reliable and widely used, it may have inherent limitations in sensitivity or the ability to detect certain resistance mechanisms compared to the MIC method [81].

The disk diffusion method for colistin susceptibility testing has been found to be unreliable due to the poor diffusion characteristics of colistin, which is a large molecule that adheres to plastic surfaces. This results in high error rates and low reproducibility, making it less suitable for accurately determining colistin resistance in Enterobacteriaceae. While this is a simple and widely used method, it tends to be less sensitive compared to MIC testing, especially for detecting low-level resistance. The observed resistance rate of 12.59% in the disk diffusion method is lower, which may indicate that this method fails to detect some resistance that other methods like MIC can identify [82].

The subgroup analysis of clinical specimens revealed significant differences in colistin resistance, with stool specimens showing the highest resistance at 42.0% (CI: 0.41%−83.36%), while blood specimens had a lower resistance rate of 3.58% (−2.03%−9.2%, p < 0.001). The higher colistin resistance observed in stool specimens can be attributed to factors such as the high bacterial diversity and the presence of selective pressures within the gut [83] while the lower colistin resistance in blood specimens is linked to the sterile nature of blood, immune system activity, and reduced bacterial colonization [84]. However, the prevalence of colistin resistance in mixed clinical isolates was steady at 25.23% (95% CI: 12.90%−37.62%).This stability may be due to the fact that the isolates came from various clinical specimens, with the rate of colistin resistance remaining relatively unchanged across different studies and samples.

Strength and limitations

This review investigates the prevalence of colistin resistance in clinical Enterobacteriaceae isolates over 14 years in Africa, revealing significant rise in resistance. The study provides crucial insights to help researchers and organizations assess the scope of the issue. However, the review had several limitations: There was significant data variability and publication bias. The exclusion of studies not published in English or lacking full texts. Additionally, correction factors used for cases with 100% prevalence or zero standard errors may have led to inflated estimates. The absence of data from certain regions could also affect the overall prevalence estimates for the continent.

Conclusion and Recommendation

Colistin resistance in Enterobacteriaceae is notably high in Africa, with significant variation between countries. This underscores the need for effective antimicrobial stewardship, improved surveillance, and the development of new antibiotics. Additionally, it highlights the importance of establishing diagnostic laboratories and ensuring access to antimicrobial susceptibility testing in resource-limited African countries.

Future perspectives

Resistance to the last-resort drugs is a global issue requiring an international alliance. The research highlights a significant rise in colistin-resistant strains and stresses the importance of molecular epidemiological studies to monitor the spread of mcr genes. It advocates for a One Health approach, integrating both clinical and non-clinical specimens, using reliable methods endorsed by CLSI and EUCAST. The study also notes gaps in data from some countries, underscoring the need for improved laboratory diagnostics and greater accessibility.

Data availability

Data used to support the findings of this study are included in this manuscript.

Abbreviations

AMR:

Antimicrobial resistance

MDR:

Multidrug-resistance

References

  1. Murray CJ, Ikuta KS, Sharara F, Swetschinski L, Aguilar GR, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629–55.

    Article  CAS  Google Scholar 

  2. Aghapour Z, Gholizadeh P, Ganbarov K, Bialvaei AZ, Mahmood SS, Tanomand A, et al. Molecular mechanisms related to colistin resistance in Enterobacteriaceae. Infect Drug Resist. 2019;12:965–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Ayandele AA, Oladipo EK, Oyebisi O, Kaka MO. Prevalence of Multi-Antibiotic Resistant Escherichia coli and Klebsiella species obtained from a Tertiary Medical Institution in Oyo State, Nigeria. Qatar Med J. 2020;2020(1):9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Exner M., Bhattacharya S., Christiansen B., Gebel J., Goroncy-Bermes P., Hartemann P., et al. Antibiotic resistance: What is so special about multidrug-resistant Gram-negative bacteria? GMS Hyg Infect Control. 2017;12.

  5. Riaz A, Obeysekera D, Ruslow K. Prevalence of Colistin Resistance among Enterobacteriaceae, A 10-year glance. OARJBP. 2021;01(01):016–24.

    Google Scholar 

  6. Ramirez D., Giron M. Enterobacter Infections. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Mariana Giron declares no relevant financial relationships with ineligible companies.: StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.; 2025.

  7. Bacterial BC, Resistance A. The Most Critical Pathogens Pathogens. 2023;12(1):116.

    Google Scholar 

  8. Sharma J, Sharma D, Singh A, Sunita K. Colistin Resistance and Management of Drug Resistant Infections. Can J Infect Dis Med Microbiol. 2022;2022:4315030.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Saha M, Sarkar A. Review on multiple facets of drug resistance: a rising challenge in the 21st century. J Xenobiotics. 2021;11(4):197–214.

    Article  CAS  Google Scholar 

  10. Sharma J, Sharma D, Singh A, Sunita K. Colistin resistance and management of drug resistant infections. Canadian Journal of Infectious Diseases and Medical Microbiology. 2022;2022(1):4315030.

    PubMed  PubMed Central  Google Scholar 

  11. Chauhan S, Kaur N, Saini AK, Chauhan J, Kumar H. Assessment of colistin resistance in Gram negative bacteria from clinical samples in resource-limited settings. Asian Pac J Trop Med. 2022;15(8):367–73.

    Article  CAS  Google Scholar 

  12. Terveer E. M., Nijhuis R. H. T., Crobach M. J. T., Knetsch C. W., Veldkamp K. E., Gooskens J., et al. Prevalence of colistin resistance gene (mcr-1) containing Enterobacteriaceae in feces of patients attending a tertiary care hospital and detection of a mcr-1 containing, colistin susceptible E. coli. PLoS One. 2017;12(6):e0178598.

  13. Amirfakhrian R, Yaghobi A, Ghaderi RS, Hashemy SI, Ghazvini K. Colistin Resistance Burden among Clinical Isolates of Gram-negative Rods: A Systematic Review and Meta-analysis. Rev Clin Med. 2020;7(2):48–70.

    Google Scholar 

  14. Aghapour Z., Gholizadeh P., Ganbarov K., Bialvaei A. Z., Mahmood S. S., Tanomand A., et al. Molecular mechanisms related to colistin resistance in Enterobacteriaceae. Infection and drug resistance. 2019:965–75.

  15. Abavisani M., Bostanghadiri N., Ghahramanpour H., Kodori M., Akrami F., Fathizadeh H., et al. Colistin resistance mechanisms in Gram-negative bacteria: a Focus on Escherichia coli. Lett Appl Microbiol. 2023;76(2).

  16. Schwarz S, Johnson AP. Transferable resistance to colistin: a new but old threat. J Antimicrob Chemother. 2016;71(8):2066–70.

    Article  PubMed  Google Scholar 

  17. Dadashi M, Sameni F, Bostanshirin N, Yaslianifard S, Khosravi-Dehaghi N, Nasiri MJ, et al. Global prevalence and molecular epidemiology of mcr-mediated colistin resistance in Escherichia coli clinical isolates: a systematic review. J Glob Antimicrob Resist. 2022;29:444–61.

    Article  CAS  PubMed  Google Scholar 

  18. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. J Clin Epidemiol. 2021;134:178–89.

    Article  PubMed  Google Scholar 

  19. Leshaba T. M. S., Mbelle N. M., Sekyere J. O. Current and emerging colistin resistance diagnostics: a systematic review of established and innovative detection methods. medRxiv. 2020:2020.08. 23.20180133.

  20. Munn Z., Moola S., Lisy K., Riitano D., Tufanaru C. Systematic reviews of prevalence and incidence. Joanna Briggs Institute reviewer’s manual. 2017:5–1.

  21. Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006;11(2):193.

    Article  PubMed  Google Scholar 

  22. Sweeting MJ, Sutton AJ, Lambert PC. What to add to nothing? Use and avoidance of continuity corrections in meta-analysis of sparse data. Stat Med. 2004;23(9):1351–75.

    Article  PubMed  Google Scholar 

  23. A Abdel Salam S., Hager R. Colistin susceptibility among multidrug resistant Gram-negative bacilli isolated from Tertiary hospital in Egypt. Nov Res Microbiol J. 2020;4(5):968–78.

  24. Abdelmagid AA, Hamoda MM, Hassan TH, Mustafa EA, Mahmoud SS, Osman EAI, et al. Detection of Plasmid-Mediated Colistin Resistance Genes in Clinical Isolates of Klebsiella pneumoniae and Escherichia coli from Some Hospitals in Khartoum. Indian J Pharm Pract. 2023;16(1):41–5.

    Article  Google Scholar 

  25. Aminata M, Alioune BS, Yacouba C, Agaly DO, Bassirou D, Abdoulaye T, et al. Multidrug-resistant bacteria isolated from nosocomial infections at University Teaching Hospital of Point-G, Bamako. Mali Afr J Bacteriol Res. 2023;15(1):1–7.

    Google Scholar 

  26. Carroll M, Rangaiahagari A, Musabeyezu E, Singer D, Ogbuagu O. Five-year antimicrobial susceptibility trends among bacterial isolates from a tertiary health-care facility in Kigali. Rwanda Am J Trop Med Hyg. 2016;95(6):1277–83.

    Article  PubMed  Google Scholar 

  27. Elbaradei A, Sayedahmed MS, El-Sawaf G, Shawky SM. Screening of mcr-1 among Gram-Negative Bacteria from Different Clinical Samples from ICU Patients in Alexandria, Egypt: One-Year Study. Pol J Microbiol. 2022;71(1):83–90.

    Article  PubMed  PubMed Central  Google Scholar 

  28. El-Kholy AA, Girgis SA, Shetta MAF, Abdel-Hamid DH, Elmanakhly AR. Molecular characterization of multidrug-resistant Gram-negative pathogens in three tertiary hospitals in Cairo. Egypt Eur J Clin Microbiol Infect Dis. 2020;39(5):987–92.

    Article  CAS  PubMed  Google Scholar 

  29. Gizachew Z., Kassa T., Beyene G., Howe R., Yeshitila B. Multi-drug resistant bacteria and associated factors among reproductive age women with significant bacteriuria. Ethiop med j. 2019:31–43.

  30. Hasanin A, Eladawy A, Mohamed H, Salah Y, Lotfy A, Mostafa H, et al. Prevalence of extensively drug-resistant gram negative bacilli in surgical intensive care in Egypt. Pan Afr Med J. 2014;19:177.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Irenge L. M., Ambroise J., Bearzatto B., Durant J. F., Bonjean M., Gala J. L. Genomic Characterization of Multidrug-Resistant Extended Spectrum β-Lactamase-Producing Klebsiella pneumoniae from Clinical Samples of a Tertiary Hospital in South Kivu Province, Eastern Democratic Republic of Congo. Microorganisms. 2023;11(2).

  32. Jalal D., Elzayat M. G., Diab A. A., El-Shqanqery H. E., Samir O., Bakry U., et al. Deciphering Multidrug-Resistant Acinetobacter baumannii from a Pediatric Cancer Hospital in Egypt. mSphere. 2021;6(6):e0072521.

  33. Mbelle N. M., Feldman C., Sekyere J. O., Maningi N. E., Modipane L., Essack S. Y. Pathogenomics and Evolutionary Epidemiology of Multi-Drug Resistant Clinical Klebsiella pneumoniae Isolated from Pretoria, South Africa. Scient Rep. 2020;10(1).

  34. Mohamed. Antimicrobial Resistance and Predisposing Factors Associated with Catheter-Associated UTI Caused by Uropathogens Exhibiting Multidrug-Resistant Patterns: A 3-Year Retrospective Study at a Tertiary Hospital in Mogadishu, Somalia. Trop Med Infect Dis. 2022.

  35. Mohamed H. S., Houmed Aboubaker M., Dumont Y., Didelot M. N., Michon A. L., Galal L., et al. Multidrug-Resistant Enterobacterales in Community-Acquired Urinary Tract Infections in Djibouti, Republic of Djibouti. Antibiotics. 2022;11(12).

  36. Ramadan RA, Bedawy AM, Negm EM, Hassan TH, Ibrahim DA, Elsheikh SM, et al. Carbapenem-Resistant Klebsiella pneumoniae Among Patients with Ventilator-Associated Pneumonia: Evaluation of Antibiotic Combinations and Susceptibility to New Antibiotics. Infect Drug Resist. 2022;15:3537–48.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Sarr H, Niang AA, Diop A, Mediannikov O, Zerrouki H, Diene SM, et al. The emergence of carbapenem-and colistin-resistant enterobacteria in Senegal. Pathogens. 2023;12(8):974.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Yousfi H, Hadjadj L, Dandachi I, Lalaoui R, Merah A, Amoura K, et al. Colistin-and carbapenem-resistant Klebsiella pneumoniae clinical_isolates: Algeria. Microb Drug Resist. 2019;25(2):258–63.

    Article  CAS  PubMed  Google Scholar 

  39. Zafer MM, El-Mahallawy HA, Abdulhak A, Amin MA, Al-Agamy MH, Radwan HH. Emergence of colistin resistance in multidrug-resistant Klebsiella pneumoniae and Escherichia coli strains isolated from cancer patients. Ann Clin Microbiol Antimicrob. 2019;18(1):40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Abdulzahra AT, Khalil MAF, Elkhatib WF. First report of colistin resistance among carbapenem-resistant Acinetobacter baumannii isolates recovered from hospitalized patients in Egypt. New Microbes New Infect. 2018;26:53–8.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Adeosun IJ, Oladipo EK, Ajibade OA, Olotu TM, Oladipo AA, Awoyelu EH, et al. Antibiotic susceptibility of klebsiella pneumoniae isolated from selected tertiary hospitals in Osun state. Nigeria Iraqi J Sci. 2019;60(7):1423–9.

    Article  Google Scholar 

  42. Adil FZ, Benaissa E, Benlahlou Y, Bakkali H, Doghmi N, Balkhi H, et al. Bacteriological aspects of bacteremia in the intensive care unit of the Mohammed V Military Hospital: 10 months prospective study. Eur J Microbiol Immunol. 2022;12(2):46–52.

    Article  CAS  Google Scholar 

  43. Azzab MM, El-Sokkary RH, Tawfeek MM, Gebriel MG. Multidrug-resistant bacteria among patients with ventilatorassociated pneumonia in an emergency intensive care unit. Egypt East Mediterr Health J. 2017;22(12):894–903.

    Article  PubMed  Google Scholar 

  44. Afolayan AO, Aboderin AO, Oaikhena AO, Odih EE, Ogunleye VO, Adeyemo AT, et al. An ST131 clade and a phylogroup A clade bearing an O101-like O-antigen cluster predominate among bloodstream Escherichia coli isolates from South-West Nigeria hospitals. Microb Genom. 2022;8(12): 000863.

    CAS  Google Scholar 

  45. Aworh MK, Kwaga JKP, Hendriksen RS, Okolocha EC, Thakur S. Genetic relatedness of multidrug resistant Escherichia coli isolated from humans, chickens and poultry environments. Antimicrob Resist Infect Control. 2021;10(1):58.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Battikh H, Harchay C, Dekhili A, Khazar K, Kechrid F, Zribi M, et al. Clonal Spread of Colistin-Resistant Klebsiella pneumoniae Coproducing KPC and VIM Carbapenemases in Neonates at a Tunisian University Hospital. Microb Drug Resist. 2017;23(4):468–72.

    Article  CAS  PubMed  Google Scholar 

  47. Büdel T, Kuenzli E, Clément M, Bernasconi OJ, Fehr J, Mohammed AH, et al. Polyclonal gut colonization with extended-spectrum cephalosporin- and/or colistin-resistant Enterobacteriaceae: a normal status for hotel employees on the island of Zanzibar. Tanzania J Antimicrob Chemother. 2019;74(10):2880–90.

    Article  PubMed  Google Scholar 

  48. Deku J. G., Duedu K. O., Kpene G. E., Kinanyok S., Feglo P. K. Carbapenemase Production and Detection of Colistin-Resistant Genes in Clinical Isolates of Escherichia Coli from the Ho Teaching Hospital, Ghana. Can J Infect Dis Med Microbiol. 2022;2022.

  49. El-Mokhtar MA, Daef E, Hussein AARM, Hashem MK, Hassan HM. Emergence of nosocomial pneumonia caused by colistin-resistant Escherichia coli in patients admitted to chest intensive care unit. Antibiotics. 2021;10(3):1–14.

    Article  Google Scholar 

  50. Kieffer N., Ahmed M., Elramalli A., Daw M., Poirela L., Álvarez R., et al. Colistin-resistant and carbapenemase producers in Klebsiella spp. and Acinetobacter baumannii in Tripoli, Libya. J Glob Antimicrob Resist. 2018;13.

  51. Konate A, Dembele R, Guessennd NK, Kouadio FK, Kouadio IK, Ouattara MB, et al. Epidemiology and Antibiotic Resistance Phenotypes of Diarrheagenic Escherichia Coli Responsible for Infantile Gastroenteritis in Ouagadougou. Burkina Faso Eur J Microbiol Immunol (Bp). 2017;7(3):168–75.

    Article  CAS  PubMed  Google Scholar 

  52. Maina JW, Onyambu FG, Kibet PS, Musyoki AM. Multidrug-resistant Gram-negative bacterial infections and associated factors in a Kenyan intensive care unit: a cross-sectional study. Ann Clin Microbiol Antimicrob. 2023;22(1):85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Messaoudi A, Mansour W, Jaidane N, Chaouch C, Boujaâfar N, Bouallègue O. Epidemiology of resistance and phenotypic characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae isolates at Sahloul University Hospital-Sousse. Tunisia African health sciences. 2019;19(2):2008–20.

    Article  PubMed  Google Scholar 

  54. Mezghani MS, Rekik MM, Mahjoubi F, Hammami A. Epidemiological study of Enterobacteriaceae resistance to colistin in Sfax (Tunisia). Médecine Mal Infect. 2012;42(6):256–63.

    Article  Google Scholar 

  55. Nabti LZ, Sahli F, Hadjadj L, Ngaiganam EP, Lupande-Mwenebitu D, Rolain JM, et al. Autochthonous case of mobile colistin resistance gene mcr-1 from a uropathogenic Escherichia coli isolate in Sétif Hospital. Algeria J Glob Antimicrob Resist. 2019;19:356–7.

    Article  PubMed  Google Scholar 

  56. Newton-Foot M., Snyman Y., Maloba M. R. B., Whitelaw A. C. Plasmid-mediated mcr-1 colistin resistance in Escherichia coli and Klebsiella spp. clinical isolates from the Western Cape region of South Africa. Antimicrob Resist Infect Control. 2017;6:1–7.

  57. Otokunefor K, Tamunokuro E, Amadi A. Molecular detection of mobilized colistin resistance (mcr-1) gene in Escherichia coli isolates from Port Harcourt. Nigeria J Appl Sci Environ Manage. 2019;23(3):401–5.

    CAS  Google Scholar 

  58. Snyman Y., Whitelaw A. C., Reuter S., Maloba M. R. B., Newton-Foot M. Colistin Resistance Mechanisms in Clinical Escherichia coli and Klebsiella spp. Isolates from the Western Cape of South Africa. Microb Drug Resist. 2021;27(9):1249–58.

  59. Sumbana J., Santona A., Fiamma M., Taviani E., Deligios M., Chongo V., et al. Polyclonal emergence of MDR Enterobacter cloacae complex isolates producing multiple extended spectrum beta-lactamases at Maputo Central Hospital, Mozambique. Rendiconti Lincei. 2022.

  60. Zakaria A. S., Edward E. A., Mohamed N. M. Genomic insights into a colistin-resistant uropathogenic escherichia coli strain of o23:H4-st641 lineage harboring mcr-1.1 on a conjugative inchi2 plasmid from egypt. Microorganisms. 2021;9(4).

  61. Poirel L, Kieffer N, Brink A, Coetze J, Jayol A, Nordmann P. Genetic Features of MCR-1-Producing Colistin-Resistant Escherichia coli Isolates in South Africa. Antimicrob Agents Chemother. 2016;60(7):4394–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. El-Mahallawy HA, El Swify M, Abdul HA, Zafer MM. Increasing trends of colistin resistance in patients at high-risk of carbapenem-resistant Enterobacteriaceae. Ann Med. 2022;54(1):2748–56.

    Article  CAS  Google Scholar 

  63. Malchione MD, Torres LM, Hartley DM, Koch M, Goodman JL. Carbapenem and colistin resistance in Enterobacteriaceae in Southeast Asia: review and mapping of emerging and overlapping challenges. Int J Antimicrob Agents. 2019;54(4):381–99.

    Article  CAS  PubMed  Google Scholar 

  64. Latifi F, Pakzad R, Asadollahi P, Hematian A, Pakzad I. Worldwide Prevalence of Colistin Resistance among Enterobacteriaceae: A Systematic Review and Meta-Analysis. Clin Lab. 2023;69:657–69.

    Article  Google Scholar 

  65. Wangchinda W, Pati N, Maknakhon N, Seenama C, Tiengrim S, Thamlikitkul V. Collateral damage of using colistin in hospitalized patients on emergence of colistin-resistant Escherichia coli and Klebsiella pneumoniae colonization and infection. Antimicrob Resist Infect Control. 2018;7:84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Latifi F., Pakzad R., Asadollahi P., Hematian A., Pakzad I. Worldwide Prevalence of Colistin Resistance among Enterobacteriaceae: a Systematic Review and Meta-Analysis. Clin Lab. 2023;69(4).

  67. Amirfakhrian R., Yaghobi A., Hashemy S. I., Ghazvini K. Colistin resistance burden among clinical isolates of gram-negative rods: A systematic review and meta-analysis. Rev Clin Med. 2020;7(2).

  68. Prim N, Turbau M, Rivera A, Rodríguez-Navarro J, Coll P, Mirelis B. Prevalence of colistin resistance in clinical isolates of Enterobacteriaceae: A four-year cross-sectional study. J Infect. 2017;75(6):493–8.

    Article  PubMed  Google Scholar 

  69. Qadi M, Alhato S, Khayyat R, Elmanama AA. Colistin resistance among Enterobacteriaceae isolated from clinical samples in Gaza Strip. Can J Infect Dis Med Microbiol. 2021;2021:1–6.

    Article  Google Scholar 

  70. Paczosa MK, Mecsas J. Klebsiella pneumoniae: going on the offense with a strong defense. Microbiol Mol Biol Rev. 2016;80(3):629–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Li Y, Kumar S, Zhang L, Wu H. Klebsiella pneumonia and Its Antibiotic Resistance: A Bibliometric Analysis. Biomed Res Int. 2022;2022:1668789.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Uzairue LI, Rabaan AA, Adewumi FA, Okolie OJ, Folorunso JB, Bakhrebah MA, et al. Global prevalence of colistin resistance in klebsiella pneumoniae from bloodstream infection: a systematic review and meta-analysis. Pathogens. 2022;11(10):1092.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Aris P, Robatjazi S, Nikkhahi F, Amin MS, M. Molecular mechanisms and prevalence of colistin resistance of Klebsiella pneumoniae in the Middle East region: A review over the last 5 years. J Glob Antimicrob Resist. 2020;22:625–30.

    Article  PubMed  Google Scholar 

  74. Bathoorn E, Tsioutis C, da Silva VJM, Scoulica EV, Ioannidou E, Zhou K, et al. Emergence of pan-resistance in KPC-2 carbapenemase-producing Klebsiella pneumoniae in Crete, Greece: a close call. J Antimicrob Chemother. 2016;71(5):1207–12.

    Article  CAS  PubMed  Google Scholar 

  75. Yusof N. Y., Norazzman N. I. I., Hakim S. N. a. W. A., Azlan M. M., Anthony A. A., Mustafa F. H., et al. Prevalence of Mutated Colistin-Resistant Klebsiella pneumoniae: A Systematic Review and Meta-Analysis. Trop Med Infect Dis. 2022;7(12):414.

  76. Toth A, Damjanova I, Puskás E, Jánvári L, Farkas M, Dobák A, et al. Emergence of a colistin-resistant KPC-2-producing Klebsiella pneumoniae ST258 clone in Hungary. Eur J Clin Microbiol Infect Dis. 2010;29:765–9.

    Article  CAS  PubMed  Google Scholar 

  77. Mueller M., Tainter C. R. Escherichia coli Infection. Treasure Island (FL): StatPearls; 2024.

  78. Moini A. S., Soltani B., Taghavi ardakani a., Moravveji A., Erami M., Haji Rezaei M., et al. Multidrug-Resistant Escherichia coli and Klebsiella pneumoniae Isolated From Patients in Kashan, Iran. Jundishapur J Microbiol. 2015;8.

  79. Anyanwu MU, Okpala COR, Chah KF, Shoyinka VS. Prevalence and Traits of Mobile Colistin Resistance Gene Harbouring Isolates from Different Ecosystems in Africa. Biomed Res Int. 2021;2021:6630379.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Chew KL, La M-V, Lin RT, Teo JW. Colistin and polymyxin B susceptibility testing for carbapenem-resistant and mcr-positive Enterobacteriaceae: comparison of Sensititre, MicroScan, Vitek 2, and Etest with broth microdilution. J Clin Microbiol. 2017;55(9):2609–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Khurana S., Malhotra R., Mathur P. Evaluation of Vitek® 2 performance for colistin susceptibility testing for Gram-negative isolates. JAC-Antimicrob Resist. 2020;2(4):dlaa101.

  82. Kaur N., Tak V., Nag V. L., Agarwal A., Bhatia P. K., Gupta N., et al. WITHDRAWN: Comparative Evaluation of Colistin Susceptibility Testing by Disk Diffusion and Broth Microdilution Methods: An Experience from a Tertiary Care Hospital. Infect Dis Drug Targets. 2022.

  83. Donà V, Bernasconi OJ, Kasraian S, Tinguely R, Endimiani A. A SYBR® Green-based real-time PCR method for improved detection of mcr-1-mediated colistin resistance in human stool samples. J Glob Antimicrob Resist. 2017;9:57–60.

    Article  PubMed  Google Scholar 

  84. Juhász E, Iván M, Pintér E, Pongrácz J, Kristóf K. Colistin resistance among blood culture isolates at a tertiary care centre in Hungary. J Glob Antimicrob Resist. 2017;11:167–70.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge all the authors that participate in this systematic review and meta-analysis.

Funding

No funding was received for this work either from any organizations or individuals.

Author information

Authors and Affiliations

  1. Department of Medical Laboratory Science, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia

    Yalewayker Gashaw, Asefa Sisay, Ermias Getatachew, Selamyhun Tadesse, Agenagnew Ashagre, Tadesse Misganaw, Muluken Gashaw, Woldeteklehaymanot Kassahun, Zelalem Dejazimach, Abdu Jemal, Solomon Gedfie, Getinet Kumie, Marye Nigatie, Wagaw Abebe & Melese Abate Reta

  2. Department of Medical Laboratory Science, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia

    Zelalem Asmare

  3. Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

    Mitkie Tigabie, Getachew Bitew & Baye Gelaw

  4. Department of Public Health, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia

    Atitegeb Abera Kidie

  5. Department of Nursing, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia

    Biruk Beletew Abate

  6. Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Prinshofaq , Pretoria, 0084, South Africa

    Melese Abate Reta

Authors
  1. Yalewayker Gashaw
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Zelalem Asmare
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Mitkie Tigabie
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Asefa Sisay
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Ermias Getatachew
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Selamyhun Tadesse
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Getachew Bitew
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Agenagnew Ashagre
    View author publications

    You can also search for this author inPubMed Google Scholar

  9. Tadesse Misganaw
    View author publications

    You can also search for this author inPubMed Google Scholar

  10. Muluken Gashaw
    View author publications

    You can also search for this author inPubMed Google Scholar

  11. Woldeteklehaymanot Kassahun
    View author publications

    You can also search for this author inPubMed Google Scholar

  12. Zelalem Dejazimach
    View author publications

    You can also search for this author inPubMed Google Scholar

  13. Abdu Jemal
    View author publications

    You can also search for this author inPubMed Google Scholar

  14. Solomon Gedfie
    View author publications

    You can also search for this author inPubMed Google Scholar

  15. Getinet Kumie
    View author publications

    You can also search for this author inPubMed Google Scholar

  16. Marye Nigatie
    View author publications

    You can also search for this author inPubMed Google Scholar

  17. Wagaw Abebe
    View author publications

    You can also search for this author inPubMed Google Scholar

  18. Atitegeb Abera Kidie
    View author publications

    You can also search for this author inPubMed Google Scholar

  19. Biruk Beletew Abate
    View author publications

    You can also search for this author inPubMed Google Scholar

  20. Melese Abate Reta
    View author publications

    You can also search for this author inPubMed Google Scholar

  21. Baye Gelaw
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

Y.G. led the systematic review and meta-analysis, overseeing the study's conceptualization, article selection, data extraction, statistical analysis, and manuscript preparation. Y.G., M.A.R, Z.A., E.G., S.T., and A.S. were involved in searching for relevant articles, conducting data extraction, performing statistical analysis, contributing to manuscript drafting, and writing editing. M.A.R., B.B.A., and A. A.K. were involved in statistical analysis consultation of the overall process of this systematic review and meta-analysis. M.T., B.G., G.B., T.M., W.A., A.A., Z.D., G.K., S.G. M.G., A.J., and W.K., involved in article searching, data extraction, statistical analysis, manuscript writing, editing, and ensuring accuracy and completeness. Additionally, all authors actively engaged in critically reviewing the study's progress, data analysis, and manuscript preparation, involved in the approval of the final manuscript for submission, thereby affirming their endorsement of its content and findings.

Corresponding author

Correspondence to Yalewayker Gashaw.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gashaw, Y., Asmare, Z., Tigabie, M. et al. Prevalence of colistin-resistant Enterobacteriaceae isolated from clinical samples in Africa: a systematic review and meta-analysis. BMC Infect Dis 25, 437 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12879-025-10826-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12879-025-10826-5

Keywords

BMC Infectious Diseases

ISSN: 1471-2334

Contact us