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The following is a summary of “Systematic review and meta-analysis of colistin heteroresistance in Klebsiella pneumoniae isolates,” published in the February 2025 issue of BMC Infectious Disease by Khoshnood et al.
Antibiotic heteroresistance occurred in various pathogenic bacteria, including Klebsiella pneumonia (K. Pneumoniae), where a subpopulation exhibited a higher minimum inhibitory concentration (MIC) than the dominant group, contributing to colistin treatment failures.
Researchers conducted a retrospective study to summarize evidence on the prevalence of colistin heteroresistance in K. pneumoniae isolates through a systematic meta-analysis.
They searched PubMed, Scopus, Embase, and Web of Science for relevant literature from 2008 to 2024. Studies were included if they investigated heteroresistant K. pneumoniae, provided the proportion of resistant isolates, specified sample sizes, and were full-text articles in English. Exclusions applied to non-English publications, case reports, single-arm or cohort studies, and pharmacokinetic research. A systematic search was performed across 4 databases—Scopus, PubMed, Web of Science, and Embase—up to a defined cut-off date. PubMed search syntax was modified for other databases. EndNote (version 20) was used to detect and eliminate duplicates.
The results showed that 18 articles were included in the meta-analysis. The random effects model estimated the pooled proportion of heteroresistant K. pneumoniae at 31.5% (95% CI: 17.9%–49.2%). Substantial heterogeneity was observed, with Q = 335.020, I2 = 94.93%, and P < 0.001, indicating significant variation in heteroresistance rates across the 18 studies.
Investigators concluded the colistin heteroresistance was prevalent in K. pneumoniae infections, emphasizing the need for updated diagnostic and treatment guidelines.
Source: bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-025-10600-7
