Molecular mechanisms related to colistin resistance in Enterobacteriaceae

Area of Science:

• Microbiology
• Infectious Diseases
• Pharmacology

Background:

• Colistin is a critical last-line antibiotic for treating multidrug-resistant Gram-negative bacterial infections.
• Increasing colistin resistance poses a significant threat due to a lack of alternative treatments.
• Resistance is observed in various bacteria, including acquired resistance in *Pseudomonas aeruginosa*, *Acinetobacter baumannii*, and Enterobacteriaceae, and natural resistance in *Serratia*, *Proteus*, and *Burkholderia* species.

Purpose of the Study:

• To review current knowledge on the mechanisms of colistin resistance.
• To highlight the clinical importance of recognizing and managing colistin resistance.
• To emphasize the need for strategic use of colistin in light of rising resistance.

Main Methods:

• Literature review of existing studies on colistin resistance mechanisms.
• Analysis of bacterial species exhibiting acquired and intrinsic colistin resistance.
• Discussion of evolutionary pathways for colistin resistance development.

Main Results:

• Colistin resistance mechanisms vary among different bacterial species.
• Both acquired (mutation/adaptation) and intrinsic resistance pathways exist.
• Clinicians must be vigilant for emerging colistin resistance in clinical settings.

Conclusions:

• Colistin remains vital, but resistance necessitates careful management and further research.
• Understanding resistance mechanisms is key to developing strategies for colistin's continued efficacy.
• The review consolidates current understanding to inform clinical practice and future antibiotic development.