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Emergent Polymyxin Resistance: End of an Era?

Zekun Li1,2,3, Yuping Cao4, Lingxian Yi4

  • 1Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.

Open Forum Infectious Diseases
|August 18, 2019
PubMed

Insights

Polymyxin antibiotics are increasingly used for resistant Gram-negative infections but face rising resistance due to overuse. This resistance, spread by the mcr gene, threatens patient care and requires effective control strategies.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Polymyxin antibiotics, once limited by toxicity, are now crucial for treating multidrug-resistant Gram-negative bacterial infections.
  • Increased use has unfortunately led to a rise in polymyxin resistance globally.
  • The dissemination of the transferable polymyxin resistance (mcr) gene in clinical and environmental settings has accelerated this resistance.

Purpose of the Study:

  • To review the current landscape of polymyxin antibiotic use, resistance trends, and clinical implications.
  • To highlight the mechanisms and spread of polymyxin resistance, including the role of mcr genes.
  • To discuss diagnostic methods, risk factors, and therapeutic options for polymyxin-resistant bacterial infections.

Main Methods:

  • Literature review of studies on polymyxin use, resistance, and clinical outcomes.
  • Analysis of factors contributing to the spread of polymyxin resistance.
  • Summary of current diagnostic techniques and treatment strategies.

Main Results:

  • Polymyxin resistance is increasing, partly due to irrational use and the spread of mcr genes.
  • Poor outcomes in colistin-resistant infections are linked to prior colistin use, severity, and multidrug resistance.
  • Effective diagnostic tests (broth microdilution, chromogenic agar, molecular assays) are available.
  • Risk factors for infection include age, prior colistin treatment, hospitalization, and ventilator support.

Conclusions:

  • The rising trend of polymyxin resistance poses a significant threat to patient care.
  • Effective control measures are urgently needed to combat the spread of polymyxin-resistant bacteria.
  • Continued surveillance and responsible antibiotic stewardship are essential.
Keywords:
mcr-1colistinpolymyxinresistance

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