Evidence map›Paper›PMID 40158103›Full record

SynthesisBMC infectious diseases2025

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

Yalewayker Gashaw, Zelalem Asmare, Mitkie Tigabie, Asefa Sisay, Ermias Getatachew, Selamyhun Tadesse, Getachew Bitew, Agenagnew Ashagre, Tadesse Misganaw, Muluken Gashaw and 11 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Colistin-resistance amongJAC-antimicrobial resistance · 2026
    Review
  5. Review
  6. Review
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors.

Yalewayker GashawDepartment of Medical Laboratory Science, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia. yalewgashaw42@gmail.com.
Zelalem AsmareDepartment of Medical Laboratory Science, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia.
Mitkie TigabieDepartment of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Asefa SisayDepartment of Medical Laboratory Science, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia.
Ermias GetatachewDepartment of Medical Laboratory Science, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia.
Selamyhun TadesseDepartment of Medical Laboratory Science, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia.
Getachew BitewDepartment of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Agenagnew AshagreDepartment of Medical Laboratory Science, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia.
Tadesse MisganawDepartment of Medical Laboratory Science, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia.
Muluken GashawDepartment of Medical Laboratory Science, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia.
Woldeteklehaymanot KassahunDepartment of Medical Laboratory Science, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia.
Zelalem DejazimachDepartment of Medical Laboratory Science, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia.
Abdu JemalDepartment of Medical Laboratory Science, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia.
Solomon GedfieDepartment of Medical Laboratory Science, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia.
Getinet KumieDepartment of Medical Laboratory Science, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia.
Marye NigatieDepartment of Medical Laboratory Science, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia.
Wagaw AbebeDepartment of Medical Laboratory Science, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia.
Atitegeb Abera KidieDepartment of Public Health, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia.
Biruk Beletew AbateDepartment of Nursing, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia.
Melese Abate RetaDepartment of Medical Laboratory Science, College of Health Sciences, Woldia University, P.O Box 400, Woldia, Ethiopia.
Baye GelawDepartment of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAntimicrobial 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.

methodsA 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 I

resultsThis 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%.

conclusionsColistin 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.

Indexed as

Anti-Bacterial AgentsColistinDrug Resistance, BacterialEnterobacteriaceaeEnterobacteriaceae InfectionsAfricaHumansMicrobial Sensitivity TestsPrevalenceAnti-Bacterial AgentsColistinAfricaClinical sampleColistin resistanceEnterobacteriaceaeMeta-analysisPrevalence

Identifiers

PMID40158103
PMCPMC11955131

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.