Colistin Resistance: From Laboratory Research to Modern Clinical Management
Abstract
Background/Objectives: Colistin, a polymyxin antibiotic introduced in the mid-20th century, has regained clinical importance as a last-resort agent for the treatment of infections caused by multidrug-resistant (MDR) Gram-negative bacteria. The global dissemination of carbapenem-resistant pathogens has intensified colistin use, leading to a concerning rise in resistance. This review aims to provide a comprehensive and up-to-date synthesis of colistin's pharmacological characteristics, resistance mechanisms, epidemiology, and current and emerging therapeutic strategies. Methods: A narrative review of the literature was conducted, encompassing studies on the chemistry, mechanism of action, pharmacodynamics, clinical use, dosing, and resistance to colistin. Data on chromosomal and plasmid-mediated resistance mechanisms, detection methodologies, epidemiological trends, and clinical outcomes were examined. In addition, evidence on colistin-based treatment strategies and novel non-antibiotic approaches was analyzed. Results: Colistin remains active against many MDR Gram-negative pathogens, including Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii; however, resistance is increasingly reported worldwide. Both chromosomally mediated modifications of lipid A and plasmid-mediated mcr genes contribute to resistance, with heteroresistance posing diagnostic and therapeutic challenges. Carbapenem resistance has emerged as a major driver of colistin use and…
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