Background: Among gram-negative bacteria, Klebsiella pneumoniae is one of the most common causes of healthcare-related infection. Bloodstream infections (BSIs) caused by Klebsiella pneumoniae are notorious for being difficult to treat due to resistance to commonly used antimicrobials. Klebsiella pneumoniae isolates from bloodstream infections are becoming increasingly resistant to carbapenems. In the fight against carbapenem-resistant Klebsiella pneumoniae, colistin [polymyxin E] is the antimicrobial of choice and is thus widely used. Objective: This study aimed to determine the global prevalence of colistin resistance amongst Klebsiella pneumoniae isolates from bloodstream infections. Methods: PubMed, Medline, Scopus, and the Cochrane Library were searched for published articles without restricting the search period. Studies meeting the predefined inclusion and exclusion criteria were included, and quality was assessed using Joanna Briggs Institute Checklist. We used a statistical random effect model to analyze data with substantial heterogeneity (I² > 50%) in the meta-analysis. Results: A total of 10 studies out of 2873 search results that met the inclusion criteria were included in the final synthesis for this study. A pooled prevalence of colistin resistance was 3.1%, 95% CI (1.5–4.7%). The highest colistin resistance pooled prevalence was recorded in isolates studied in 2020 and beyond 12.90% (4/31), while Klebsiella pneumoniae isolates studied in 2015 and before and in 2016–2019 showed a pooled colistin resistance rate of 2.89% (48/1661) and 2.95% (28/948), respectively. The highest colistin resistance was found in Klebsiella pneumoniae isolates from Thailand (19.2%), while the least pooled resistance was in Klebsiella pneumoniae from South Korea (0.8%). The pooled prevalence of the multidrug-resistant (MDR) of Klebsiella pneumoniae from bloodstream infection ranged from 80.1%, 95% CI (65.0–95.2%), and the resistance prevalence of other antibiotics by Klebsiella pneumoniae from bloodstream infections were as follows; ciprofloxacin (45.3%), ertapenem (44.4%), meropenem (36.1%), imipenem (35.2%), gentamicin (33.3%), amikacin (25.4%) and tigecycline (5.1%). Klebsiella pneumoniae recovered from the intensive care unit (ICU) showed higher colistin resistance, 11.5% (9/781%), while non-ICU patients showed 3.03% (80/2604) pooled colistin resistance. Conclusion: This study showed low colistin resistance in Klebsiella pneumoniae isolates from global bloodstream infections. However, significant colistin resistance was observed in isolates collected from 2020 and beyond. Significant colistin resistance was also observed in Klebsiella pneumoniae isolates in bloodstream infections from the intensive care unit (ICU) compared to those from non-ICUs. As a result, there is a need to institute colistin administration stewardship in the ICU in clinical settings.

Microorganisms colonizing the oral cavity have a significant probability of spreading on epithelial surfaces to neighboring sites. Many reports have associated oral bacteria to oral infectious diseases as well as systemic diseases such as cardiovascular disease and diabetes. Oral care is usually neglected in the control of health problems linked with diabetes which may contribute to the increased morbidity and complications from oral health problems. The study aimed to identify the resident microbial flora and assess the possible carriage of cariogenic bacteria among people with diabetes in Ado- Ekiti, Nigeria. Oral swabs were collected from 306 consenting patients. Culture-based isolation was done using standard techniques on Mitis salivarius agar supplemented with 1% Potassium Tellurite, 10% chocolate agar and MacConkey agar at 37 oC for 18-48 hours. The susceptibility patterns of the isolates were detected using standard techniques as recommended by CLSI. Selected bacteria isolates were genomically identified using the bacterial universal primer 16S rRNA and STR-1 and STR 2 primers (partial tuf genes). Amplified genes were sequenced and phylogenetic analysis was carried out using MEGA 7 software. A total of 447 microbial isolates were identified among which were Staphylococcus spp (14.5%), Klebsiella pneumoniae (3.4%), Escherichia coli (2.5%), Candida spp (8%) while the streptococcal organisms such as Streptococcus pyogenes (35.2%), Streptococcus mitis (14%), Streptococcus mutans (7.3%)and Streptococcus salivarius (15.1%). Streptococcus mutans was susceptible to meropenem (71.4%) but highly resistant to Penicillin (100%), cefuroxime (71.4%) cefotaxime (68.6%). Streptococcus mitis was highly resistant to Amoxicillin/Clavulanate (100%), Cloxacillin (100%) and Cefuroxime (70.1%) but was found susceptible to Meropenem (77.3%). 16S ribosomal RNA gene amplification and subsequent sequencing of the isolates revealed twenty-six (26) de-novo bacterial strains. In conclusion, the study showed that diabetic individuals carry multidrug-resistant cariogenic bacteria that may predispose them to other oral diseases. There is a need to incorporate routine oral microbiological screening into routine care for diabetic patients in Nigeria.