Colistin-resistant Enterobacteriaceae infections: clinical and molecular characterization and analysis of in vitro synergy

Multidrug-resistant Klebsiella pneumoniae: genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in Brazil

“…The pmrA T245A and R255G; arnB D112A; and udg I17V and Yins217 mutations were present in all six isolates; the yciM N212T and lpxM S285G mutations were also present in 5 and 4 isolates, respectively. The role of these mutations is not yet clear, but their simultaneous presence in all those genes that are already known to be involved with colistin-resistance in the colRKP isolates suggest that they may also lead to polymyxin-resistance 20 - 24 . Four different MLST were identified, and although there were three isolates from MLST 11, they did not share the same mutations, which suggest that they were not from a clonal lineage, corroborating the clustering analysis results.…”

Emergent Polymyxin Resistance: End of an Era?

“…Prognosis for patients with infections caused by polymyxin-resistant bacteria also needs to be considered. CoRB infections in critically-ill patients (including pneumonia, urine tract infection, bacteremia, infection with underlying diseases as transplantation, stroke, chronic obstructive pulmonary disease [COPD], and so on) are associated with high mortality rates (30%–37%) [68–70]. Patients infected with CoRB but without previous exposure to colistin would have a significantly better outcome [71].…”

“…Patients infected with CoRB but without previous exposure to colistin would have a significantly better outcome [71]. Also, high mortality rates with CoRB infection was associated with dialysis (63.6%, 7 of 11), septic shock (37.5%–60%, 9 of 24–9 of15), and intraabdominal infection (83.3%, 10 of 12) [68, 72]. For patients with respiratory system infection, COPD and lower respiratory tract infection contributed to a nearly 3-fold higher mortality rate than the control group, which could be explained by several increased factors, such as medical ventilation, damage of pulmonary function, treatment with corticosteroids, and so on [73].…”

Predicting and managing sepsis in burn patients: current perspectives

“… 118 , 119 However, due to the use of colistin, the appearance of colistin-resistant organisms is worrisome, as available therapeutic options seem scarce; some studies have reported the usefulness of combination therapy (eg, colistin, amikacin, tigecycline) in the treatment of colistin-resistant infections. 120 , 121 Early consultation of infectious diseases specialists is advocated in challenging cases. A duration of at least 7 days of systemic antibiotics is recommended.…”