Overcoming mcr-1 mediated colistin resistance with colistin in combination with other antibiotics

Nat Commun. 2018 Jan 31;9(1):458. doi: 10.1038/s41467-018-02875-z.

Abstract

Plasmid-borne colistin resistance mediated by mcr-1 may contribute to the dissemination of pan-resistant Gram-negative bacteria. Here, we show that mcr-1 confers resistance to colistin-induced lysis and bacterial cell death, but provides minimal protection from the ability of colistin to disrupt the Gram-negative outer membrane. Indeed, for colistin-resistant strains of Enterobacteriaceae expressing plasmid-borne mcr-1, clinically relevant concentrations of colistin potentiate the action of antibiotics that, by themselves, are not active against Gram-negative bacteria. The result is that several antibiotics, in combination with colistin, display growth-inhibition at levels below their corresponding clinical breakpoints. Furthermore, colistin and clarithromycin combination therapy displays efficacy against mcr-1-positive Klebsiella pneumoniae in murine thigh and bacteremia infection models at clinically relevant doses. Altogether, these data suggest that the use of colistin in combination with antibiotics that are typically active against Gram-positive bacteria poses a viable therapeutic alternative for highly drug-resistant Gram-negative pathogens expressing mcr-1.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Anti-Bacterial Agents / pharmacology*
  • Bacteremia / drug therapy
  • Colistin / pharmacology*
  • Drug Resistance, Bacterial / genetics
  • Drug Therapy, Combination
  • Enterobacter aerogenes / drug effects*
  • Enterobacter aerogenes / genetics
  • Enterobacter cloacae / drug effects*
  • Enterobacter cloacae / genetics
  • Enterobacteriaceae / drug effects
  • Enterobacteriaceae / genetics
  • Enterobacteriaceae Infections / drug therapy
  • Enterobacteriaceae Infections / microbiology
  • Escherichia coli / drug effects*
  • Escherichia coli / genetics
  • Escherichia coli Infections / drug therapy
  • Escherichia coli Infections / microbiology
  • Escherichia coli Proteins / genetics
  • Ethanolaminephosphotransferase / genetics
  • Klebsiella Infections / drug therapy
  • Klebsiella Infections / microbiology
  • Klebsiella pneumoniae / drug effects*
  • Klebsiella pneumoniae / genetics
  • Mice
  • Microbial Sensitivity Tests

Substances

  • Anti-Bacterial Agents
  • Escherichia coli Proteins
  • MCR-1 protein, E coli
  • Ethanolaminephosphotransferase
  • Colistin