{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T19:11:48Z","timestamp":1792523508452,"version":"4.5.0"},"reference-count":48,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,9,24]],"date-time":"2022-09-24T00:00:00Z","timestamp":1663977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Background: 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 &gt; 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\u20134.7%). 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\u20132019 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\u201395.2%), 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.<\/jats:p>","DOI":"10.3390\/pathogens11101092","type":"journal-article","created":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T03:34:17Z","timestamp":1664163257000},"page":"1092","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":71,"title":["Global Prevalence of Colistin Resistance in Klebsiella pneumoniae from Bloodstream Infection: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2547-175X","authenticated-orcid":false,"given":"Leonard Ighodalo","family":"Uzairue","sequence":"first","affiliation":[{"name":"Department of Medical Laboratory Science, Faculty of Basic Medical Science, Federal University, Oye-Ekiti 371104, Ekiti State, Nigeria"},{"name":"Department of Microbiology, College of Bioscience, Federal University of Agriculture, Abeokuta 111101, Ogun State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6774-9847","authenticated-orcid":false,"given":"Ali A.","family":"Rabaan","sequence":"additional","affiliation":[{"name":"Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia"},{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"},{"name":"Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumilayo Ajoke","family":"Adewumi","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, College of Medicine, Ekiti State University, Ado-Ekiti 362103, Ekiti State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Obiageli Jovita","family":"Okolie","sequence":"additional","affiliation":[{"name":"Department of Applied Sciences, University of West England, Bristol BS16 1QY, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamiu Bello","family":"Folorunso","sequence":"additional","affiliation":[{"name":"Medical Microbiology Unit, Department of Medical Laboratory, Directorate of Health Services, Olabisi Onibanjo University, Ago-Iwoye 120107, Ogun State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2284-3979","authenticated-orcid":false,"given":"Muhammed A.","family":"Bakhrebah","sequence":"additional","affiliation":[{"name":"Life Science and Environment Research Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Garout","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and Health Care for Pilgrims, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4501-5316","authenticated-orcid":false,"given":"Wadha A.","family":"Alfouzan","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Kuwait University, Safat 13110, Kuwait"},{"name":"Microbiology Unit, Department of Laboratories, Farwania Hospital, Farwania 85000, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad A.","family":"Halwani","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Faculty of Medicine, Al Baha University, Al Baha 4781, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aref A.","family":"Alamri","sequence":"additional","affiliation":[{"name":"Department of Molecular Microbiology and Cytogenetics, Riyadh Regional Laboratory, Riyadh 11425, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7463-1492","authenticated-orcid":false,"given":"Shaima A.","family":"Halawani","sequence":"additional","affiliation":[{"name":"Department of Molecular Microbiology and Cytogenetics, Riyadh Regional Laboratory, Riyadh 11425, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatimah S.","family":"Alshahrani","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh 11451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0391-306X","authenticated-orcid":false,"given":"Abdulkarim","family":"Hasan","sequence":"additional","affiliation":[{"name":"Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt"},{"name":"Prince Mishari Bin Saud Hospital in Baljurashi, Ministry of Health, Baljurash 22888, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbas Al","family":"Mutair","sequence":"additional","affiliation":[{"name":"Research Center, Almoosa Specialist Hospital, Al-Ahsa 36342, Saudi Arabia"},{"name":"College of Nursing, Princess Norah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia"},{"name":"School of Nursing, Wollongong University, Wollongong, NSW 2522, Australia"},{"name":"Nursing Department, Prince Sultan Military College of Health Sciences, Dhahran 33048, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4552-4513","authenticated-orcid":false,"given":"Saad","family":"Alhumaid","sequence":"additional","affiliation":[{"name":"Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnson","family":"Etafo","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Federal Medical Centre, Owo 341105, Ondo State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Idorenyin","family":"Utip","sequence":"additional","affiliation":[{"name":"School of Medical and Health Sciences, Bangor University, Bangor LL57 2EF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4585-7166","authenticated-orcid":false,"given":"Ikenna Maximillian","family":"Odoh","sequence":"additional","affiliation":[{"name":"University Medical Centre, Federal University, Oye-Ekiti 371104, Ekiti State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nkolika S.","family":"Uwaezuoke","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Federal Medical Centre, Abuja 310001, Federal Capital Territory, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.jgar.2020.02.030","article-title":"Prevalence of multidrug-resistant Gram-negative bacteria cases at admission in a multispeciality hospital","volume":"22","author":"Nagvekar","year":"2020","journal-title":"J. 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