Colistin Resistance Gram-Negative Bacteria as an Emerging Public Health Threat

The increasing resistance of multidrug-resistant (MDR) bacteria has become a major threat to public health and has led to the use of polymyxins, with their toxicity, as a last resort in the treatment of infections caused by multidrug-resistant bacterial strains. Currently, two polymyxins are available, polymyxin E (colistin) and polymyxin B. In the mid-1990s, Colistin was introduced as a treatment for infections caused by MDR Gram-negative bacteria (GNB). Unfortunately, resistance to colistin has rapidly emerged after its introduction into treatment protocols against these resistant strains. Considering this, our study focused on the recently discovered mechanisms of colistin resistance, starting from China and then other countries around the world to elucidate the mechanisms of colistin resistance and track the spread of colistin-resistant bacterial strains, which would provide essential information on various aspects of the increasing prevalence of colistin-resistant bacteria. In this context, this review highlights the progress made over the past two decades in understanding the mechanisms of action of colistin and the different strategies used by bacteria to develop colistin resistance, as well as provides an update on what was previously known and what is new, to evaluate the monitoring colistin resistance and identifying resistance trends which deserves further study and development of future strategies to control the spread of multidrug-resistant pathogens.