Polymyxin sensitivity/resistance cosmopolitan status, epidemiology and prevalence among O1/O139 and non-O1/non-O139 Vibrio cholerae : A meta-analysis

• Published in: Infectious medicine Vol. 2; no. 4; pp. 283 - 293
• Main Authors: Igere, Bright E, Onohuean, Hope, Iwu, Declan C, Igbinosa, Etinosa O
• Format: Journal Article
• Language: English
• Published: China Elsevier 01.12.2023
• Subjects: Biotyping scheme; Clinical O1/O139 V. cholerae; Environmental nonO1/nonO139 V. cholerae; Global epidemiological relevance; PB-sensitive/PB-resistant strains; Polymyxin B; Review; Clinical O1/O139 V. cholerae; Environmental nonO1/nonO139 V. cholerae; Global epidemiological relevance; PB-sensitive/PB-resistant strains; Polymyxin B; Biotyping scheme
• ISSN: 2772-431X; 2097-0684; 2772-431X
• DOI: 10.1016/j.imj.2023.11.004

Resistance/sensitivity to polymyxin-B (PB) antibiotic has been employed as one among other epidemiologically relevant biotyping-scheme for into Classical/El Tor biotypes. However, recent studies have revealed some pitfalls bordering on PB-sensitivity/resistance (PBR/S) necessitating study. Current study assesses the PBR/S cosmopolitan prevalence, epidemiology/distribution among O1/O139 and nonO1/nonO139 strains. Relevant databases (Web of Science, Scopus and PubMed) were searched to retrieve data from environmental and clinical samples employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Random-effect-model (REM) and common-effect-model (CEM) of meta-analysis was performed to determine prevalence of PBR/S strains, describe the cosmopolitan epidemiological potentials and biotype relevance. Heterogeneity was determined by meta-regression and subgroup analyses. The pooled analyzed isolates from articles (7290), with sensitive and resistance are 2219 (30.44%) and 5028 (69.56%). Among these PB-sensitive strains, more than 1944 (26.67%) were O1 strains, 132 (1.81%) were nonO1 strains while mis-reported Classical biotype were 2080 (28.53) respectively indicating potential spread of variant/dual biotype. A significant PB-resistance was observed in the models (CEM = 0.66, 95% CI [0.65; 0.68], -value = 0.001; REM = 0.83 [0.74; 0.90],  = 0.001) as both models had a high level of heterogeneity (  = 98.0%; ). Egger test ( = 5.4017, < 0.0001) reveal publication bias by funnel plot asymmetry. The subgroup analysis for continents (Asia, Africa) and sources (acute diarrhea) revealed (98% CI (0.73; 0.93); 55% CI (0.20; 0.86)), and 92% CI (0.67; 0.98). The Epidemiological prevalence for El tor/variant/dual biotype showed 88% CI (0.78; 0.94) with O1 strains at 88% CI (0.78; 0.94). Such global prevalence, distribution/spread of phenotypes/genotypes necessitates updating the decades-long biotype classification scheme. An antibiotic stewardship in the post antibiotic era is suggestive/recommended. Also, there is need for holistic monitoring/evaluation of clinical/epidemiological relevance of the disseminating strains in endemic localities.