A systematic review and meta-analysis of carbapenem resistance and its possible treatment options with focus on clinical Enterobacteriaceae: Thirty years of development in Pakistan

This systematic review and meta-analysis investigates the current carbapenem resistance situation in Pakistan and its treatment options. The study identified 343 studies, with a pooled prevalence of 12% in Enterobacteriaceae and 24% in Klebsiella pneumoniae. Over the last two decades, carbapenem resistance has increased from 0% to 36%. The fundamental genetic determinant for carbapenem resistance in Enterobacteriaceae in Pakistan is blaNDM. Treatment options for multidrug resistant infections not responding to carbapenems include polymyxin B, colistin, tigecycline, and fosfomycin. The study concludes that NDM-1-producing carbapenem resistant Enterobacteriaceae are increasing in Pakistan, with metallo-β-lactamases producing E. coli ST405 and K. pneumoniae sequence type11 being the major resistant clones. A National antimicrobial resistance (AMR) surveillance strategy based on One Health is urgently needed to check any future AMR crisis in Pakistan.