Colistin and its role in the Era of antibiotic resistance: an extended review (2000-2019)

• Published in: Emerging microbes & infections Vol. 9; no. 1; pp. 868 - 885
• Main Authors: El-Sayed Ahmed, Mohamed Abd El-Gawad, Zhong, Lan-Lan, Shen, Cong, Yang, Yongqiang, Doi, Yohei, Tian, Guo-Bao
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 01.01.2020; Taylor & Francis Ltd; Taylor & Francis Group
• Subjects: Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Colistin; Colistin - pharmacology; Colistin - therapeutic use; Drug resistance; Drug Resistance, Multiple, Bacterial; Gram-Negative Bacteria - drug effects; Gram-Negative Bacteria - pathogenicity; Gram-Negative Bacterial Infections - drug therapy; Gram-Negative Bacterial Infections - microbiology; heteroresistance; Humans; MCR-1; multidrug resistance; Multidrug resistant organisms; Pathogens; Review; two-component systems; multidrug resistance; two-component systems; Colistin; heteroresistance; MCR-1
• ISSN: 2222-1751; 2222-1751
• DOI: 10.1080/22221751.2020.1754133

Increasing antibiotic resistance in multidrug-resistant (MDR) Gram-negative bacteria (MDR-GNB) presents significant health problems worldwide, since the vital available and effective antibiotics, including; broad-spectrum penicillins, fluoroquinolones, aminoglycosides, and β-lactams, such as; carbapenems, monobactam, and cephalosporins; often fail to fight MDR Gram-negative pathogens as well as the absence of new antibiotics that can defeat these "superbugs". All of these has prompted the reconsideration of old drugs such as polymyxins that were reckoned too toxic for clinical use. Only two polymyxins, polymyxin E (colistin) and polymyxin B, are currently commercially available. Colistin has re-emerged as a last-hope treatment in the mid-1990s against MDR Gram-negative pathogens due to the development of extensively drug-resistant GNB. Unfortunately, rapid global resistance towards colistin has emerged following its resurgence. Different mechanisms of colistin resistance have been characterized, including intrinsic, mutational, and transferable mechanisms. In this review, we intend to discuss the progress over the last two decades in understanding the alternative colistin mechanisms of action and different strategies used by bacteria to develop resistance against colistin, besides providing an update about what is previously recognized and what is novel concerning colistin resistance.