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Polymyxin Resistance in Gram-negative Pathogens

  • Antimicrobial Development and Drug Resistance (A Pakyz, Section Editor)
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Abstract

Purpose of Review

The polymyxins are one of the last line antimicrobial classes to retain activity against multidrug-resistant Gram-negative bacilli. However, with the increased use of polymyxins in recent years, reports of resistance have also been increasing. We aimed to describe the mechanisms and occurrence of polymyxin resistance in Gram-negative organisms and propose strategies to overcome resistance.

Recent Findings

The most common mechanism of acquired resistance to the polymyxins is via modification of the bacterial outer membrane lipopolysaccharide. Global epidemiological surveillance studies have reported the occurrence of polymyxin resistance to be most common in Enterobacteriaceae, specifically Enterobacter species and Acinetobacter baumannii. Prevalence of polymyxin-resistant Gram-negative organisms varies significantly by geographical location.

Summary

Emergence of polymyxin resistance is of great concern, given the limited number of agents available to treat infections caused by multidrug-resistant Gram-negative organisms. Strategies to mitigate the development of polymyxin resistance include dose optimization and using polymyxin agents in combination with other highly active antimicrobial agents.

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Acknowledgments

We thank Elizabeth Neuner, PharmD for assisting with technical editing, language editing, and proofreading of this manuscript.

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  1. Department of Pharmacy, Cleveland Clinic, 9500 Euclid Ave (Hb-105), Cleveland, OH, 44195, USA

    Pavithra Srinivas & Kaitlyn Rivard

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  1. Pavithra Srinivas
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Correspondence to Pavithra Srinivas.

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Srinivas, P., Rivard, K. Polymyxin Resistance in Gram-negative Pathogens. Curr Infect Dis Rep 19, 38 (2017). https://doi.org/10.1007/s11908-017-0596-3

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