Colistin-resistant Gram-negative bacteria in Saudi Arabia: A literature review

Abstract

Gram-negative bacteria (GNB) represent a major source of morbidity worldwide. The antimicrobial resistance of GNB has recently increased worldwide, that led to using colistin to treat multidrug resistant (MDR) GNB infections. Annually, Saudi Arabia hosts mass religious occasions, where the risk of infectious disease transmission is very high. This review aimed to provide an update on the current prevalence and molecular epidemiology of colistin-resistant GNB locally. It also assessed the role of mass gatherings in triggering colistin resistance. Although colistin is still highly effective against GNB isolates locally, high colistin resistance has been identified among major GNB such as Acinetobacter baumannii and Klebsiella pneumoniae. Colistin resistance among certain MDR Escherichia coli clones, such as ST131, has recently emerged and this is alarming given the rapid global dissemination of this clone. Local data has shown the role of mass religious gatherings in triggering the acquisition of colistin resistance, which makes the screening of colistin resistance determinants very important to limit the spread of colistin resistant GNB between pilgrims.