<p>Molecular mechanisms related to colistin resistance in Enterobacteriaceae</p>

Abstract

Colistin is an effective antibiotic for treatment of most multidrug-resistant Gram-negative bacteria. It is used currently as a last-line drug for infections due to severe Gram-negative bacteria followed by an increase in resistance among Gram-negative bacteria. Colistin resistance is considered a serious problem, due to a lack of alternative antibiotics. Some bacteria, including <i>Pseudomonas aeruginosa</i>, <i>Acinetobacter baumannii</i>, Enterobacteriaceae members, such as <i>Escherichia coli, Salmonella</i> spp., and <i>Klebsiella</i> spp. have an acquired resistance against colistin. However, other bacteria, including <i>Serratia</i> spp., <i>Proteus</i> spp. and <i>Burkholderia</i> spp. are naturally resistant to this antibiotic. In addition, clinicians should be alert to the possibility of colistin resistance among multidrug-resistant bacteria and development through mutation or adaptation mechanisms. Rapidly emerging bacterial resistance has made it harder for us to rely completely on the discovery of new antibiotics; therefore, we need to have logical approaches to use old antibiotics, such as colistin. This review presents current knowledge about the different mechanisms of colistin resistance.