Colistin, Mechanisms and Prevalence of Resistance.
Curr Med Res Opin. 2015 Feb 20;:1-54
Authors: Bialvaei AZ, Samadi Kafil H
Abstract Background: Infections caused by multidrug-resistant Gram-negative bacteria, particularly Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae, that cause nosocomial infections represent a growing problem worldwide. The rapid increase in the prevalence of Gram-negative pathogens that are resistant to fluoroquinolones and aminoglycosides as well as all β-lactams, including carbapenems, monobactam, cephalosporins and broad-spectrum penicillins, has prompted the reconsideration of colistin as a valid therapeutic option. Colistin is an old class of cationic, which act by disrupting the bacterial membranes resulting in cellular death. Although, there has been a significant recent increase in the data gathered on colistin, focusing on its chemistry, antibacterial activity, mechanism of action and resistance, pharmacokinetics, pharmacodynamics and new clinical application, the prevalence of colistin resistant very little has been reported in literatures. This review concentrated on recent literatures aimed at optimizing the clinical use of this important antibiotic. Methods: The available evidence from various studies (microbiological and clinical studies, retrieved from the PubMed, and Scopus databases) regarding the mechanisms and prevalence of resistance was evaluated. Results: Increasing use of colistin for treatment of infections caused by these bacteria has led to the emergence of colistin resistance in several countries worldwide. Although resistance to polymyxins is generally less than 10%, but is higher in the Mediterranean and South-East Asia (Korea and Singapore), which colistin resistance rates are continually increasing. Conclusion: There is a critical need for effective infection prevention and control measures and strict use of antibiotics in the world to control the rise and spread of colistin resistance.
PMID: 25697677 [PubMed – as supplied by publisher]