Polymyxin Resistance in Gram-Negative Bacteria

Dear Colleagues,

Infections due to multi-drug-resistant (MDR), extensively drug-resistant (XDR) and pan-drug-resistant (PDR) Gram-negative bacteria are one of the major challenges for clinicians. Available treatment options for these infections are minimal and include a few new antibacterials developed recently but also old antibacterials, such as polymyxins, that are still recognized as a last-line choice for the treatment-resistant infections. Polymyxins were introduced into clinical practice more than 50 years ago; however, they were soon abandoned because of severe toxicity reports. Although a better characterization of the polymyxins’ pharmacokinetics (PKs) in recent years has led to better dosing schemes and to better efficacy, there are still issues, such as resistance, that lead their use to be dangerous. Resistance to polymyxins in Gram-negative bacteria emerged over time through various mechanisms. It is mainly due to lipopolysaccharide modifications, as well as the plasmid-mediated mobile colistin resistance gene (mcr). Today, resistance to polymyxins has worldwide prevalence among Gram-negative pathogens, with rates constantly rising, and it poses a serious public health concern. The co-existence of polymyxin resistance with resistance to other classes of antibacterials further complicates the problem. The use of polymyxins in livestock farming and agriculture and the subsequent environmental contamination with polymyxin-resistant bacteria also pose a growing public health threat.

The aim of this Special Issue is to update the knowledge on polymyxins resistance through the contribution of manuscripts highlighting epidemiology, resistance mechanisms, and genomics of polymyxin-resistant Gram-negative bacteria, but also manuscripts addressing treatment issues of polymyxin-resistant infections, such as combination therapy and polymyxins’ PK/PD studies. Finally, manuscripts describing new microbiological tools for polymyxin resistance detection and manuscripts presenting One Health approaches to mitigate polymyxin resistance are also welcome.

Dr. Sophia Vourli
Guest Editor

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• multi-drug resistance
• polymyxins PK/PD
• combination therapy
• mcr genes
• One Health