Clinical and laboratory-induced colistin-resistance mechanisms in Acinetobacter baumannii
Christine J Boinett1,2,3, Amy K Cain1,4, Jane Hawkey5,6,7
11Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK.
Abstract:
The increasing incidence and emergence of multi-drug resistant (MDR) Acinetobacter baumannii has become a major global health concern. Colistin is a historic antimicrobial that has become commonly used as a treatment for MDR A. baumannii infections. The increase in colistin usage has been mirrored by an increase in colistin resistance. We aimed to identify the mechanisms associated with colistin resistance in A. baumannii using multiple high-throughput-sequencing technologies, including transposon-directed insertion site sequencing (TraDIS), RNA sequencing (RNAseq) and whole-genome sequencing (WGS) to investigate the genotypic changes of colistin resistance in A. baumannii. Using TraDIS, we found that genes involved in drug efflux (adeIJK), and phospholipid (mlaC, mlaF and mlaD) and lipooligosaccharide synthesis (lpxC and lpsO) were required for survival in sub-inhibitory concentrations of colistin. Transcriptomic (RNAseq) analysis revealed that expression of genes encoding efflux proteins (adeI, adeC, emrB, mexB and macAB) was enhanced in in vitro generated colistin-resistant strains. WGS of these organisms identified disruptions in genes involved in lipid A (lpxC) and phospholipid synthesis (mlaA), and in the baeS/R two-component system (TCS). We additionally found that mutations in the pmrB TCS genes were the primary colistin-resistance-associated mechanisms in three Vietnamese clinical colistin-resistant A. baumannii strains. Our results outline the entire range of mechanisms employed in A. baumannii for resistance against colistin, including drug extrusion and the loss of lipid A moieties by gene disruption or modification.
Insights
Multi-drug resistant Acinetobacter baumannii is a growing threat. Researchers used advanced sequencing to uncover colistin resistance mechanisms, identifying key genes in drug efflux and cell wall synthesis. This reveals how bacteria evade this crucial antibiotic.
Area of Science:
- Microbiology
- Genomics
- Antimicrobial Resistance
Background:
- Multi-drug resistant (MDR) Acinetobacter baumannii poses a significant global health challenge.
- Colistin, a vital antibiotic for MDR A. baumannii infections, faces increasing resistance.
- Understanding colistin resistance mechanisms is crucial for developing effective treatments.
Purpose of the Study:
- To comprehensively identify the genetic and molecular mechanisms of colistin resistance in Acinetobacter baumannii.
- To investigate genotypic alterations associated with colistin resistance using high-throughput sequencing.
Main Methods:
- Transposon-directed insertion site sequencing (TraDIS) to identify essential genes under colistin pressure.
- RNA sequencing (RNAseq) to analyze gene expression changes in resistant strains.
- Whole-genome sequencing (WGS) to detect mutations and genetic disruptions in resistant isolates.
Main Results:
- TraDIS identified genes in drug efflux (adeIJK), phospholipid synthesis (mlaC, mlaF, mlaD), and lipooligosaccharide synthesis (lpxC, lpsO) as critical for colistin survival.
- RNAseq showed enhanced expression of efflux pump genes (adeI, adeC, emrB, mexB, macAB) in resistant strains.
- WGS revealed mutations in lipid A synthesis (lpxC), phospholipid synthesis (mlaA), and the BaeS/R two-component system (TCS), with PmrB mutations being primary in Vietnamese clinical strains.
Conclusions:
- Multiple mechanisms contribute to colistin resistance in A. baumannii, including enhanced drug efflux and alterations in cell envelope synthesis.
- Gene disruptions or modifications affecting lipid A and phospholipid pathways are key resistance strategies.
- The study elucidates the full spectrum of colistin resistance mechanisms in A. baumannii, highlighting drug extrusion and lipid A modification.
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