Colistin Resistance among Multi-Drug Resistant Gram-Negative Bacteria in Iran: A Systematic Review and Meta-Analysis

Background: Colistin, a last-resort antibiotic, faces a growing threat from antibiotic resistance. This study aims to comprehensively assess colistin resistance in clinical isolates of Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae in Iran. Materials and Methods: Relevant studies on the prevalence of colistin resistance among multidrug-resistant Gram-negative bacteria in Iran, published up to December 15, 2023, were identified through searches of databases such as PubMed/Medline, EMBASE, and Scopus. The overall frequency of colistin resistance for each bacterial species was determined using CMA version 3. Results: The comprehensive analysis of clinical isolates revealed varying frequencies of colistin resistance among the studied Gram-negative bacteria. E. coli displayed a resistance rate of 3.6%, while P. aeruginosa exhibited a rate of 6.5%. A. baumannii demonstrated a resistance rate of 4.7%, and K. pneumoniae displayed the highest resistance rate at 7.2%. Importantly, the analysis found no significant evidence of publication bias, enhancing the reliability of these resistance rate estimates. Conclusion: Colistin resistance among these clinically significant Gram-negative bacteria in Iran is rising, limiting treatment options and posing serious challenges to healthcare providers. These findings underscore the urgency of enhanced surveillance, the development of alternative treatments, and the implementation of strict infection control measures. Addressing colistin resistance is crucial to effectively managing infections caused by these pathogens in Iran and globally.