Li Na, Ebrahimi Elaheh, Sholeh Mohammad, Dousti Reyhane, Kouhsari Ebrahim
Zhejiang Provincial Headquarters Hospital of the Chinese People's Armed Police Force Zhejiang, Hangzhou, China.
Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
APMIS. 2025 Jan;133(1):e13508. doi: 10.1111/apm.13508.
Colistin is a last-resort treatment for multidrug-resistant Gram-negative bacterial infections, particularly in critically ill patients. Nevertheless, it remains a major threat to public health. We assessed the proportion of colistin-resistant Gram-negative isolates from intensive care unit (ICU) infections in different years, areas, pathogens, and antimicrobial susceptibility tests (AST). We searched the studies in PubMed, Scopus, Embase, and Web of Science (until November 2021). Statistical analyses were conducted using STATA software (ver. 14.0). The overall rate of colistin resistance was 5.18% (95% CI 2.70%-8.22%). The proportion of colistin resistance was 4% (95% CI 2%-7%) before 2015 and 6% (95% CI 4%-9%) in 2015-2019. The rates of colistin resistance in Europe, America, Asia, and Africa were 8.24%, 3.78%, 3.60%, and 0%, respectively. The proportion of colistin-resistant non-fermenting Gram-negative bacilli isolated from the ICU was 2.25% (Acinetobacter baumannii [1.68%] and Pseudomonas aeruginosa [3.30%]). A 4-fold increase in colistin resistance was observed when comparing EUCAST and CLSI. We described the global epidemiology of colistin resistance over time and shown the distribution of colistin-resistant strains in different countries. Robust antimicrobial stewardship programs can increase the success of ICU physicians in improving patient outcomes.
黏菌素是治疗多重耐药革兰氏阴性菌感染的最后手段，尤其是在重症患者中。然而，它仍然是公共卫生的一大威胁。我们评估了不同年份、地区、病原体和抗菌药物敏感性试验（AST）中重症监护病房（ICU）感染的耐黏菌素革兰氏阴性菌分离株的比例。我们在PubMed、Scopus、Embase和Web of Science（截至2021年11月）中检索了相关研究。使用STATA软件（版本14.0）进行统计分析。黏菌素耐药的总体发生率为5.18%（95%CI 2.70%-8.22%）。2015年前黏菌素耐药的比例为4%（95%CI 2%-7%），2015-2019年为6%（95%CI 4%-9%）。欧洲、美洲、亚洲和非洲的黏菌素耐药率分别为8.24%、3.78%、3.60%和0%。从ICU分离出的耐黏菌素非发酵革兰氏阴性杆菌的比例为2.25%（鲍曼不动杆菌[1.68%]和铜绿假单胞菌[3.30%]）。比较EUCAST和CLSI时，观察到黏菌素耐药性增加了4倍。我们描述了黏菌素耐药性随时间的全球流行病学情况，并展示了不同国家耐黏菌素菌株的分布。强有力的抗菌药物管理计划可以提高ICU医生改善患者预后的成功率。
