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Review
. 2024 Apr 11;12(4):772.
doi: 10.3390/microorganisms12040772.

A Review on Colistin Resistance: An Antibiotic of Last Resort

Aftab Hossain Mondal  1 , Kriti Khare  2 , Prachika Saxena  2 , Parbati Debnath  1 , Kasturi Mukhopadhyay  2 , Dhananjay Yadav  3
Affiliations
Review

A Review on Colistin Resistance: An Antibiotic of Last Resort

Aftab Hossain Mondal et al. Microorganisms. .

Abstract

Antibiotic resistance has emerged as a significant global public health issue, driven by the rapid adaptation of microorganisms to commonly prescribed antibiotics. Colistin, previously regarded as a last-resort antibiotic for treating infections caused by Gram-negative bacteria, is increasingly becoming resistant due to chromosomal mutations and the acquisition of resistance genes carried by plasmids, particularly the mcr genes. The mobile colistin resistance gene (mcr-1) was first discovered in E. coli from China in 2016. Since that time, studies have reported different variants of mcr genes ranging from mcr-1 to mcr-10, mainly in Enterobacteriaceae from various parts of the world, which is a major concern for public health. The co-presence of colistin-resistant genes with other antibiotic resistance determinants further complicates treatment strategies and underscores the urgent need for enhanced surveillance and antimicrobial stewardship efforts. Therefore, understanding the mechanisms driving colistin resistance and monitoring its global prevalence are essential steps in addressing the growing threat of antimicrobial resistance and preserving the efficacy of existing antibiotics. This review underscores the critical role of colistin as a last-choice antibiotic, elucidates the mechanisms of colistin resistance and the dissemination of resistant genes, explores the global prevalence of mcr genes, and evaluates the current detection methods for colistin-resistant bacteria. The objective is to shed light on these key aspects with strategies for combating the growing threat of resistance to antibiotics.

Keywords: antibiotic resistance; colistin resistance; mcr genes; mechanism of resistance; prevalence.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Mechanisms of action of colistin against Gram-negative bacteria. (A) Classical membrane lysis pathway; (B) vesicle–vesicle contact pathway; (C) hydroxyl radical death pathway; (D) respiratory enzyme inhibition pathway; (E) anti-endotoxin activity of colistin. (Created with BioRender.com).
Figure 2
Figure 2
Mechanisms of colistin resistance in Gram-negative bacteria. (created with BioRender.com).
Figure 3
Figure 3
Summary of colistin mechanism of action, resistance, global prevalence, and detection method for better surveillance in Gram-negative bacteria.
See this image and copyright information in PMC

References

    1. Aghapour Z., Gholizadeh P., Ganbarov K., Bialvaei A.Z., Mahmood S.S., Tanomand A., Yousefi M., Asgharzadeh M., Yousefi B., Kafil H.S. Molecular mechanisms related to colistin resistance in Enterobacteriaceae. Infect. Drug Resist. 2019;12:965–975. doi: 10.2147/IDR.S199844. - DOI - PMC - PubMed
    1. Terreni M., Taccani M., Pregnolato M. New antibiotics for multidrug-resistant bacterial strains: Latest research developments and future perspectives. Molecules. 2021;26:2671. doi: 10.3390/molecules26092671. - DOI - PMC - PubMed
    1. Gogry F.A., Siddiqui M.T., Sultan I., Haq Q.M.R. Current update on intrinsic and acquired colistin resistance mechanisms in bacteria. Front. Med. 2021;8:677720. doi: 10.3389/fmed.2021.677720. - DOI - PMC - PubMed
    1. Hassan J., El-Gemayel L., Bashour I., Kassem I.I. Antibiotics and Antimicrobial Resistance Genes in the Environment. Elsevier; Amsterdam, The Netherlands: 2020. On the edge of a precipice: The global emergence and dissemination of plasmid-borne mcr genes that confer resistance to colistin, a last-resort antibiotic; pp. 155–182.
    1. Rubens R.S., Arruda I.d.S.A., Almeida R.M., Nóbrega Y.K.d.M., Carneiro M.d.S., Dalmolin T.V. Challenges in the Detection of Polymyxin Resistance: From Today to the Future. Microorganisms. 2024;12:101. doi: 10.3390/microorganisms12010101. - DOI - PMC - PubMed

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