Plasmid-Determined Colistin Resistance in the North African Countries: A Systematic Review

We have conducted a systematic review to update available information on plasmid-mediated colistin resistance (mobilized colistin resistance [mcr]) genes in North African countries. We have searched the articles of PubMed, Scopus, and Web of Science databases reporting plasmid-mediated colistin resistance bacteria isolated in North African countries. After searching and selection, 30 studies that included 208mcr-positive isolates were included. Differentmcr-positive strains frequencies were recorded and ranged from 2% in clinical isolates to 12.3% in environmental samples.Escherichia coliwas the predominant species recorded and these microorganisms showed high resistance to ciprofloxacin and cotrimoxazole. IncHI2 plasmids are probably the key vectors responsible for the dissemination ofmcrgenes in these countries. This review highlighted that themcr-positive isolates are circulating in different ecological niches with different frequencies. Therefore, actions should be implemented to prevent the dissemination of themcrgenes within and outside of these countries, such as microbiological and molecular surveillance programs and restriction use of colistin in farming.

Automated summary

In this study, a systematic review was conducted to update information on plasmid-mediated colistin resistance genes in North African countries. The review identified different frequencies of mcr-positive strains in various samples, with Escherichia coli as the predominant species showing high resistance to certain antibiotics. The IncHI2 plasmids were highlighted as likely key vectors responsible for disseminating mcr genes in these countries, emphasizing the need for preventative actions to curb their spread through surveillance programs and restrictions on colistin use.