Researchers have expressed alarm over Africa’s high levels of resistance to a last-resort antibiotic in an already multidrug-resistant (MDR) bacterial pathogen, according to their recent study.
CIDRAP reports that in a systematic review and meta-analysis, published in JAC-Antimicrobial Resistance, the researchers from Woldia University in Ethiopia examined data from 30 studies that reported on colistin resistance in clinical specimens of MDR Klebsiella pneumoniae collected from hospitals in Africa.
With mortality rates ranging from 40% to 70%, MDR K pneumoniae has been identified as a high-priority global health threat by the World Health Organisation.
Colistin is one of the few remaining options for treating MDR K pneumoniae infections.
“Colistin resistance in K. pneumoniae is often associated with high morbidity and mortality, especially in critically ill patients, and its spread poses a serious challenge to treatment options across the African continent,” the study authors wrote.
Highest levels in East Africa
The 30 studies covered 11 African countries: Egypt, Nigeria, South Africa, Uganda, Kenya, the Democratic Republic of the Congo, Algeria, Ethiopia, Mali, Ghana and Mozambique. Nearly half of the reviewed studies (13) were conducted in Egypt.
The overall pooled prevalence of colistin resistance was 21.6%, with high heterogeneity and significant sub-regional variation. By sub-region, East Africa had the highest pooled prevalence of colistin resistance (42.3%), followed by West Africa (37.1%), Southern Africa (17.1%), and North Africa (13%).
By country, colistin resistance was highest in Nigeria (39.1%), Kenya (22.5%), South Africa (17.2%), and Egypt (14%).
The authors said the findings support the need for greater regulation of colistin use to maintain its effectiveness.
“Despite the considerable heterogeneity across the included studies and the limited or absent data from some countries, the estimated pooled prevalence provides a valuable indicator of colistin resistance in Africa,” they wrote. “Further research is essential, particularly studies focusing on colistin stewardship and improving access to rapid diagnostic tools for detecting this resistance across the continent.”
Study details
Prevalence of colistin resistance in multidrug-resistant Klebsiella pneumoniae recovered from clinical samples in Africa: a systematic review and meta-analysis
Yalewayker Gashaw, Zelalem Asmare, Assefa Sisay et al.
Published in JAC-Antimicrobial Resistance on 18 July 2025
Abstract
Background
Colistin resistance in multidrug-resistant (MDR) Klebsiella pneumoniae is a growing concern in Africa, complicating treatment and public health management. Colistin is a last-resort antibiotic for Gram-negative infections, but its resistance in clinical settings presents significant challenges. This study aims to determine the pooled prevalence of colistin resistance in MDR K. pneumoniae isolates from clinical specimens in Africa.
Methods
Articles were sourced from PubMed, Scopus, ScienceDirect and Google Scholar. Studies included were those reporting colistin resistance in MDR K. pneumoniae from clinical specimens in Africa, using EUCAST and CLSI-standard drug susceptibility testing. Data were extracted into Excel and analysed using STATA 17 with a random-effects model to determine the pooled prevalence. Heterogeneity was assessed using the I2 statistic, and publication bias was checked with Egger’s test. Subgroup analyses were performed to explore heterogeneity.
Results
The study analysed data from 30 articles on colistin resistance in MDR K. pneumoniae. The pooled prevalence was 21.59% (95% CI: 12.12–31.06), with high heterogeneity (I2 = 99.71%). Sub-regional variation was significant (P < 0.001), with prevalence rates differing across regions: 42.34% in East Africa, 37.1% in West Africa, 17.1% in Southern Africa and 13.0% in North Africa. Country-specific rates were highest in Nigeria (39.12%), followed by Kenya (22.52%), South Africa (17.12%) and Egypt (14.0%) (P < 0.001).
Conclusions
Colistin resistance in MDR K. pneumoniae is high in Africa, with notable regional differences. The study calls for strict colistin regulations, robust antimicrobial stewardship and rapid diagnostic tools for resistance detection.
CIDRAP article – High prevalence of colistin-resistant Klebsiella found in Africa (Open access)
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