A Review of colistin-resistant Escherichia coli isolates in Middle East: Mechanisms, epidemiology, and dissemination from different origins in human, animal, food, and soil

Escherichia coli is a normal gut inhabitant, that is able to cause various diseases such as enteric, urinary tract, cystitis, and systemic infections in humans and animals. The alarming increase in the prevalence of profiles for the extended-spectrum β-lactamase producing and carbapenemase-producing Escherichia coli isolates is a serious problem all over the world. Colistin is well known as a last-resort antibiotic for the treatment of gram-negative bacterial infections. Inappropriate use of colistin and other classes of antibiotics in combination with poor infection control especially in developing countries could lead to serious complications in public health settings. The global increase of colistin resistance has been reported in many parts of the world, as well as in the Middle East region. Colistin is used to treat infections caused by extensively drug-resistant gram-negative bacteria. The reliable epidemiological data of the colistin-resistant in E. coli isolates is very scarce, however, information for colistin-resistant E. coli from Asia, the world's largest, most populous, and most diverse continent, is generally limited in comparison to Europe and the United States of America. The data of this review article were collected from the respective articles in connection with isolated colistin-resistant Escherichia coli (E. coli) isolates from humans, animals, and food-producing animals sections. In the Middle east, colistin-resistant E. coli isolates has been reported from Turkey, Egypt, Saudi Arabia, Algeria, Iran, Iraq, Bahrain, Qatar, Oman, Kuwait, Israel, and Lebanon between 2010 and 2022. While colistin resistance is most frequently observed in E. coli isolates, data indicated that the mcr genes have been found to be the most common genes associated with colistin resistance in E. coli isolates, in comparison with mutations in the pmrAsB, phoQ, and mgrB genes.