Colistin resistance of Acinetobacter baumannii: clinical reports, mechanisms and antimicrobial strategies

• Published in: Journal of antimicrobial chemotherapy Vol. 67; no. 7; pp. 1607 - 1615
• Main Authors: Cai, Yun, Chai, Dong, Wang, Rui, Liang, Beibei, Bai, Nan
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-07-2012; Oxford Publishing Limited (England)
• Subjects: Acinetobacter baumannii; Acinetobacter baumannii - drug effects; Acinetobacter Infections - drug therapy; Acinetobacter Infections - epidemiology; Acinetobacter Infections - microbiology; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimicrobial agents; Asia - epidemiology; Bacteria; Biological and medical sciences; Carbapenems; Colistin; Colistin - pharmacology; Colistin - therapeutic use; Drug resistance; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination - methods; Europe - epidemiology; Humans; Lipopolysaccharides; Medical sciences; Medical treatment; Peptides; Pharmacodynamics; Pharmacokinetics; Pharmacology. Drug treatments; Prevalence; Rifampin; Asia; Europe; multidrug resistance; Drug combination; Treatment resistance; Colistin; heteroresistance; Cyclic peptides; Report; Neisseriaceae; Antimicrobial agent; Acinetobacter baumannii; Antibiotic; Polypeptide; Multiple resistance; Bacteria; Micrococcales; Strategy; combination therapy; Combined treatment; Antibacterial agent; Mechanism of action
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dks084

Colistin is the last resort for treatment of multidrug-resistant Acinetobacter baumannii. Unfortunately, resistance to colistin has been reported all over the world. The highest resistance rate was reported in Asia, followed by Europe. The heteroresistance rate of A. baumannii to colistin is generally higher than the resistance rate. The mechanism of resistance might be loss of lipopolysaccharide or/and the PmrAB two-component system. Pharmacokinetic/pharmacodynamic studies revealed that colistin monotherapy is unable to prevent resistance, and combination therapy might be the best antimicrobial strategy against colistin-resistant A. baumannii. Colistin/rifampicin and colistin/carbapenem are the most studied combinations that showed promising results in vitro, in vivo and in the clinic. New peptides showing good activity against colistin-resistant A. baumannii are also being investigated.