COLISTIN RESISTANCE IN COMBAT AGAINST ACINETOBACTER BAUMANNII: A MULTI-ASPECT COMPREHENSIVE REVIEW EXPLORING COLISTIN RESISTANCE IN ACINETOBACTER BAUMANNII, ITS MECHANISM, CLINICAL IMPLICATIONS, EPIDEMIOLOGY, AND GLOBAL BURDEN WITH SPECIAL FOCUS ON NOSOCOMIAL INFECTIONS.

Main Article Content

Hira Tariq
Waseem Sajjad
Dr. Saddam Aslam
Zareen Akhtar
Hafiz Nadir Murtaza
Wajahat Ullah Ismail

Keywords

Colistin Resistance, Acinetobacter baumannii, Nosocomial infections, Antibiotic resistance

Abstract

Nosocomial infections are the leading cause of major spread of all available antibiotic-resistant bacteria till date. Among these, Acinetobacter baumannii is the most important host of hospital-associated outbreaks due to its developed resistance to all available antibiotics which make clinicians to rely on a buried drug called colistin to put it in use which is the only option left. Acinetobacter marks the overburden of nosocomial morbidities ultimately compromising the country's economy. But now this horrible organism adopts resistance to this graved drug not only by chromosomal but by plasmid-mediated mechanism conferring horizontal gene transfer. Colistin belongs to the class Bacillus polymyxa is a cationic peptide that targets the negative charge of LPS of all gram-negative bacteria. Major genetic factors involve the mutated genes(lpxACD) leading to complete loss of LPS and two component system (PmrAB system) that causes the overexpression of PmrC homologue eptA, modify the LPS by adding petN to lipid A moiety with some other TCS are also detected like AdeABC operon. Plasmid mediation done due to mcr1 genes and its variants which were arise from the animals due to excessive use of colistin as a metaphylactic approach disturbing the one health perspective. By examining the various factors that contribute to the resistance of last resort treatment for hospital infections, it becomes evident that significant measures must be taken to combat the highly resistant Acinetobacter bacterium and the antibiotics listed by the WHO. Many countries using it as a growth promoter in animals, banned its consumption due to the prevalent resistant mechanism in critically important pathogens. The fast emergence of variations is stigmatizing for society. Hence, it is crucial to thoroughly assess and monitor the resistance mechanisms in bacteria and the therapeutic window of colistin by surveillance that meets the requirements of the continuing research program. Due to the narrow therapeutic range of colistin, it is crucial to secure its targeting structures (particularly homologue eptA) and monitor its use. This is necessary to control the prevalent resistance to colistin, which is the main cause of high mortality rates, especially in hospitals. It is important to implement appropriate antimicrobial resistance (AMR) surveillance strategies at regional, national, and international levels to effectively manage colistin as a last resort treatment for nosocomial infections. Our review focus on the resistance mechanism toward this drug in this particular nosocomial pathogen to manage its prevalence in the world which is making way to develop a new therapeutic option to consider.

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