From the Guidelines
Colistin resistance is a significant global health concern, with the most recent and highest quality evidence suggesting that it is increasingly prevalent in various geographical regions, particularly in Asia, where rates can reach up to 25% in some clinical settings 1.
Epidemiology and Prevalence
The epidemiology of colistin resistance is complex and influenced by several factors, including the widespread use of colistin as a growth promoter in livestock, international travel, food trade, and migration patterns. The prevalence of colistin resistance varies across different regions, with the highest rates observed in Asia, particularly in countries like China, India, and Southeast Asian nations.
- In Europe, colistin resistance remains relatively low, ranging from 1-5%, with higher rates in southern European countries compared to northern regions 1.
- North America generally maintains low resistance rates, below 2%, while Latin America shows moderate levels ranging from 5-15% 1.
- The Middle East and Africa demonstrate significant variability, with some countries reporting concerning resistance rates of 10-20% 1.
Geographical Distribution
The geographical distribution of colistin resistance is influenced by various factors, including the use of colistin in agriculture, healthcare practices, and international travel.
- Colistin resistance primarily emerges through chromosomal mutations or through mobile genetic elements carrying the mcr genes (particularly mcr-1 through mcr-10), which can transfer resistance between bacterial species 1.
- The global spread of colistin resistance has been facilitated by international travel, food trade, and migration patterns, highlighting the need for coordinated global efforts to address this issue.
Addressing Colistin Resistance
Addressing colistin resistance requires a multifaceted approach, including:
- Antimicrobial stewardship: optimizing the use of antibiotics, including colistin, to minimize the development of resistance 1.
- Improved surveillance: enhancing laboratory standards and reporting systems to monitor the spread of colistin resistance 1.
- Restricted agricultural use: limiting the use of colistin as a growth promoter in livestock to reduce the selective pressure for resistance development 1.
- Development of alternative treatments: investing in the development of new antibiotics and therapies to treat multidrug-resistant infections 1.
From the Research
Epidemiology of Colistin Resistance
- The global prevalence of colistin resistance is a significant concern, with a recent study finding that more than 79% of publications on the topic were published between 2014 and 2020 2.
- The prevalence of mobile colistin resistance (mcr)-harbouring colistin-resistant E. coli varies by region, with the highest rates found in Asia (66.72%) and Europe (25.49%) 2.
Geographical Distribution of Colistin Resistance
- Colistin resistance has been reported in several countries worldwide, with higher rates found in the Mediterranean and South-East Asia (Korea and Singapore) 3.
- The dissemination of mcr genes conferring colistin resistance has been reported in various sectors, including human clinical isolates, animals, and the environment 4.
Prevalence of Colistin Resistance
- The prevalence of colistin resistance is generally less than 10%, but it is increasing in several countries, particularly in Asia and Europe 3.
- A study found that the emergence of colistin-resistant organisms was detected in 10.3% of patients with infections caused by carbapenem-resistant Gram-negative organisms, with no difference observed between patients receiving colistin monotherapy and those receiving colistin-meropenem combination therapy 5.