Colistin: The phoenix Arises

Abstract

The polymyxins were discovered in the 1940s and represent a group of closely related polypeptide antibiotics obtained fromBacillus polymyxa, which was originally isolated from soil (1,2). Although they have been used extensively worldwide in topical otic and ophthalmic solutions for decades, the intravenous formulations were gradually abandoned in most parts of the world in the early 1980s because of the reported high incidence of nephrotoxicity (3-5). As a result, the use of polymyxin preparations has been mainly restricted to the treatment of lung infections due to multidrug-resistant (MDR) gram-negative bacteria in patients with cystic fibrosis (6,7). The emergence of bacteria resistant to most classes of commercially available antibiotics and the shortage of novel antimicrobial agents with activity against gram-negative microorganisms have led to the reemergence of polymyxins as a valuable addition to the therapeutic armamentarium. It was thus considered timely to review colistin and its emerging role in managing infections due to MDR gram-negative bacteria.

Outbreak of infections due to KPC-2-producing Klebsiella pneumoniae in a hospital in Crete (Greece)

“…2,28e30 Emergence of resistance to these agents during prolonged or suboptimal treatment has been reported. 28,31 In the current study, KPC-producing K. pneumoniae strains were repeatedly isolated while on treatment. Given the fact that one fourth of our patients were already receiving colistin at the time of the first isolation, the possibility of emergence of resistant strains to this agent should be tested.…”

Prevalence of Carbapenem Resistant Klebsiella and Proteus Clinical Isolates: A Real Threat to the Egyptian Health Care System

“…However, the combinations of carbapenems (IPM and MEM) with colistin (COL) were not tested against the P. vulgaris clinical isolates, as colistin has no activity against Proteus spp. (Conly and Johnston, 2006). The efficacy of all tested combinations varied between synergism, moderate synergism and additivity.…”

Metallo-β-lactamases in Gram-negative bacteria: introducing the era of pan-resistance?

“…and Enterobacter sp. [100]. In vitro colistin demonstrates synergy when administered in combination with rifampicin or minocycline [101,102].…”