Ashton et al., "Detection of the plasmid-mediated mcr-1 gene conferring
colistin resistance in human and food isolates of Salmonella enterica and Escherichia coli in England and Wales," Journal of Antimicrobial Chemotherapy, vol.
In order to deal with such situation Tigecycline, polymyxins (
colistin and polymyxinB) and Fosfomycin are considered possible candidate therapies for infections caused by CPE.
[2] This trend correlates with the mounting rates of MDR and extensively drug-resistant (XDR) Gram-negative pathogens, which include the carbapenemase-producing Enterobacteriaceae (CPE), which often require the use of older, more toxic drugs such as
colistin as last-resort salvage therapy for critically ill patients in hospital settings.
The discounter came bottom in a league table published by the Alliance (ASOA) this week, which measured the efforts of the UK's biggest supermarkets on a list of seven criteria: readily available policy; restrictions on antibiotics deemed critically important to human health (CIAs); monitoring usage; bans on
colistin; bans on routine use of antibiotoics; publication of usage data; and reduction strategies in place.
The following antimicrobial groups according to the Anatomical Therapeutic Chemical classification (12) were analysed; J01CR05 and J01CR01 (combination ofpenicillins, including combinations of the beta-lactamase inhibitor; piperacillin/tazobactam and ampicillin/sulbactamA J01DD (thirdgeneration cephalosporins; ceftriaxone and ceftazidime), J01DH (carbapenems; meropenem and imipenem), J01GB (aminoglycosides; gentamicin and amikacin), J01MA (fluoroquinolones; ciprofloxacin and levofloxacin), J01AA12 (tigecycline) and J01XB01 (
colistin).
Colistin resistance was not found in Pseudomonas spp.
morganii (Mm-141, and Mm-234) exhibited an extreme level of resistance against [beta]-lactam and non [beta]-lactam classes of antimicrobials, whereas out of 23 antibiotics Enterobacter cloacae (Ec-93 and Ec-188) were sensitive to tigecycline and Citrobacter freundii (Cf-276) to polymyxin-B, tigecycline and
colistin only.
The growing epidemic of infections in the ICU caused by MDR pathogens has led clinicians to reconsider prescribing pPB and
colistin (polymyxin E) drugs that were removed from use in the past because of their neuro-and nephro-toxicity.17 An earlier study evaluated the efficacy of PB in MDR pathogens when there is very narrow choice.18 In case of A.
Target site antimicrobial activity of
colistin might be misestimated if tested in conventional growth media.
Colistin was removed in 2016 and the use of Fluoroquinolones has been cut by 91% in six years.
In addition, Novodiag CarbaR+ identifies a plasmid-mediated resistance to
colistin.
Colistin is considered the drug of last resort for many infections.