• Journal of Microbiology and Biotechnology
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• 제26권9호
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• pp.1620-1628
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• 2016

In this study, we investigated colistin resistance mechanisms associated with the regulation of the pbgP operon in Klebsiella pneumoniae, using four isogenic pairs of colistin-susceptible strains and their colistin-resistant derivatives and two colistin-resistant clinical isolates. Amino acid sequence alterations of PhoPQ, PmrAB, and MgrB were investigated, and mRNA expression levels of phoQ, pmrB, pmrD, and pbgP were measured using quantitative real-time PCR. The phoQ and pmrB genes were deleted from two colistin-resistant derivatives, 134R and 063R. We found that phoQ, pmrD, and pbgP were significantly upregulated in all colistin-resistant derivatives. However, pmrB was significantly upregulated in only two colistin-resistant derivatives and one clinical strain. pmrB was not overexpressed in the other strains. The minimum inhibitory concentration of colistin was drastically lower in both phoQ- and pmrB-deleted mutants from a colistin-resistant derivative (134R) that was overexpressing phoQ and pmrB. However, colistin susceptibility was restored only in a phoQ-deleted mutant from a colistin-resistant derivative (063R) without overexpression of pmrB. In conclusion, two different regulations of the pbgP operon may associate with the development of colistinresisant K. pneumoniae.

• Annals of Laboratory Medicine
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• 제38권6호
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• pp.545-554
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• 2018

Background: The increasing morbidity and mortality rates associated with Acinetobacter baumannii are due to the emergence of drug resistance and the limited treatment options. We compared characteristics of colistin-resistant Acinetobacter baumannii (CR-AB) clinical isolates recovered from patients with and without prior colistin treatment. We assessed whether prior colistin treatment affects the resistance mechanism of CR-AB isolates, mortality rates, and clinical characteristics. Additionally, a proper method for identifying CR-AB was determined. Methods: We collected 36 non-duplicate CR-AB clinical isolates resistant to colistin. Antimicrobial susceptibility testing, Sanger sequencing analysis, molecular typing, lipid A structure analysis, and in vitro synergy testing were performed. Eleven colistin-susceptible AB isolates were used as controls. Results: Despite no differences in clinical characteristics between patients with and without prior colistin treatment, resistance-causing genetic mutations were more frequent in isolates from colistin-treated patients. Distinct mutations were overlooked via the Sanger sequencing method, perhaps because of a masking effect by the colistin-susceptible AB subpopulation of CR-AB isolates lacking genetic mutations. However, modified lipid A analysis revealed colistin resistance peaks, despite the population heterogeneity, and peak levels were significantly different between the groups. Conclusions: Although prior colistin use did not induce clinical or susceptibility differences, we demonstrated that identification of CR-AB by sequencing is insufficient. We propose that population heterogeneity has a masking effect, especially in colistin non-treated patients; therefore, accurate testing methods reflecting physiological alterations of the bacteria, such as phosphoethanolamine-modified lipid A identification by matrix-assisted laser desorption ionization-time of flight, should be employed.

• 한국임상약학회지
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• 제27권4호
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• pp.207-213
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• 2017

Background: It is recommended to use aerosolized (AS) colistin in patients undergoing mechanical ventilation therapy as an adjunctive in the latest guidelines, in spite of high nephrotoxicity and limited studies. In this study, systematic reviews and meta-analyzes were conducted to evaluate the safety and efficacy of AS colistin in patients with ventilator-associated pneumonia Methods: Two authors independently searched related literature published from Pubmed and EMBASE until July 2016 and included a study comparing adjunctive AS colistin with intravenous (IV) colistin monotherapy. The primary outcome was the clinical response rate, the secondary outcome was the overall mortality, and nephrotoxicity. The publication bias was evaluated using the Egger's test. Results: Of the total 279 articles, nine were finally included in the final analysis. There was a significant difference between the adjunctive AS colistin group and the IV colistin monotherapy group for the treatment-response rate (odds ratio (OR), 1.56; 95% CI, 1.14-2.14; p = 0.005; $I^2=36%$), although there was no significant difference in overall mortality (OR, 0.77; 95% CI, 0.57-1.04; p = 0.09; $I^2=20%$). However, there was no significant difference between the two groups in nephrotoxicity (OR, 1.13; 95% CI, 0.74-1.74; p = 0.57; $I^2=4%$). Conclusion: The addition of aerosolized colistin to IV colistin monotherapy showed better results in terms of efficacy than IV colistin monotherapy and did not show any significant difference in terms of total mortality and nephrotoxicity. Additional large-scale studies of this need to be verified.

• 한국임상수의학회지
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• 제14권2호
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• pp.215-222
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• 1997

Enrofloxacin-colistin combination, widely used in Gram negative infections in veterinary sector, was investigated in terms of MIC and initial killing rate using E coli k 88ab, Salmonella typhimurium, Pasteurella multocida type A, Bordetella bronchiseptica and Staphylococcus aureus as test organisms. On the basis of MICs of enrofloxacin-colistin combination against the above bacteria, killing rates of the combination of enrofloxacin and colistin at the ratio of 5:0, 4:1, 3:2, 1:1, 2:3, 1:4 and 0:5, indicated high and rapid antibacterial acitivities against all but Staphylococcus aureus R-209, with the number of bacteria reducing to less than one percent within two hours. At the MIC of enrofloxacin or colistin, both antibacterials showed the highest killing rates during 2-4 hours against Gram negatives such as E coli K88ab,Pasteurella multocida type A and Bodetella bronchiseptica but allowed the regrowth of the same pathogens thereafter. On the while, the combination of two antibacterials at a fourth MIC resulted in high killing rate without bacterial regrowth during 24 hours, suggesting the synergistic antivacterial effects. The combination, however, did not show favourable activity against Gram negatime S typhimurium and Gram positive S aureus ergistic antibacterial activity against Gram negatime pathogens but also colistin showed LPS-neutraization, we could suggest the combination should provide clinically positive therapeutic armarium in Gram negative infections.

• Pediatric Infection and Vaccine
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• 제27권1호
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• pp.45-52
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• 2020

목적: Carbapenem-resistant Acinetobacter baumannii (CRAB)에 의한 인공호흡기연관 폐렴(ventilator-associated pneumonia, VAP)의 치료에 있어 고용량 ampicillin-sulbactam과 colistin의 병합요법 치료효과를 살펴보기 위한 예비 연구이다. 방법: 2017년도 6월부터 2018년도 8월까지 17명의 CRAB VAP 환자를 후향적으로 분석하였다. 10명(58.8%)의 환자는 고용량 ampicillin-sulbactam과 colistin 병합요법(병합치료군)으로 치료받았으며, 나머지 7명은 colistin 단독치료를 하였거나 colistin을 포함 또는 미포함하는 다양한 항균제의 병합치료(기타치료군)를 하였다. 본 연구는 두 그룹간의 임상 및 세균학적 결과를 비교하였다. 결과: 병합치료군에서 항균제 사용 후 발열기간은 1.30±1.70일이었고, 기타치료군에서는 1.71±1.49일이었다. 기관내관 흡인물 검체에서 균이 음전 될 때까지의 평균 기간은 병합치료군에서 3.40±1.71일 기타치료군에서 11.80±8.86일이었다(P=0.030). 항균제 치료 30일 이내 사망률은 병합치료균에서 1/10 (10%)이고 기타치료군에서 3/7 (42.9%)이었다. 결론: 소아의 CRAB에 의한 인공호흡기연관 폐렴 환자에서 고용량 ampicillin-sulbactam과 colistin의 병합요법이 임상적 예후를 개선시킬 수 있을 것으로 기대된다.

• 한국생물공학회:학술대회논문집
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• 한국생물공학회 2002년도 생물공학의 동향 (X)
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• pp.224-227
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• 2002

Colistin produced from Penibacillius polymyxa was widely used as an antibiotic active against gram-negative bacteria and as feed additive. This research studied on increment of colistin productivity by mutation of P. polymyxa. As a result, several mutants were obtained from the strain by UV radiation and NTG treatment. They produced approximately 8.5${\sim}$9.0 g/L of colistin in flask and jar culture. Colistin productivity of the mutant, named Penibacillius polymyxa CBY, showed 100 times than that of wild type. When Penibacillius polymyxa CBY fermented in the optimal medium, it produced up to 18 g/L of colistin in jar fermentation.

• Tuberculosis and Respiratory Diseases
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• 제64권1호
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• pp.8-14
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• 2008

연구배경: Acinetobacter baumannii는 항생제에 대한 내성균이 자주 발생하며 MDR Acinetobacter baumannii 감염의 치료 시 항생제 선택에 어려움이 있다. Colistin은 그람 음성균에 효과적이며 MDR Acinetobacter균에 감수성을 보이나 전신투여 시 신독성, 신경독성 등의 부작용으로 인해 잘 쓰이지 않는 약제이다. 전신투여에 의한 부작용을 회피하는 방법으로 분무치료가 있다. 그러나 MDR Acinetobacter baumannii 페렴환자에서 colistin 분무치료의 효과와 부작용에 대한 국내연구는 부족한 실정이어서 저자들은 다음과 같은 연구를 시행하였다. 방법: 2006년 12월부터 2007년 8월까지 중환자실의 폐렴환자 중에서 호흡기검체 배양검사를 통해 imipenem에 내성을 포함한 MDR Acinetobacter baumannii균에 의한 폐렴이 진단된 환자를 대상으로 하였다. 이들 중 항생제 정맥주사와 더불어 하루 3번의 colistin 분무치료를 시행했던 환자들의 의무기록을 후향적으로 분석하여 임상 소견, 신기능, 인공호흡기의 최대기도압의 변화를 분석 하였다 결과: 총 31명의 환자에서 colistin 분무치료를 시행하였다. Colistin 사용기간은 $14{\pm}7$일이었으며, 하루 흡입용량은 225~300 mg이었다. Colistin 분무치료 후 25명/31명(80.6%)에서 Acinetobacter균이 제거되었으나 이 중 11명(44%)에서는 2차 감염에 의한 새로운 균이 배양되었다. Colistin 분무치료 전, 후로 백혈구 수는 감소하였다. Colistin 분무치료 후 신기능의 장애는 발생하지 않았으며 의미 있는 기관지경련의 소견도 관찰되지 않았다. 결론: 적절한 항생제를 선택하기 어려운 MDR Acinetobacter baumanii에 의한 폐렴을 치료하는데 colistin 분무치료는 비교적 높은 균 제거율과 낮은 부작용을 보이므로 고려해 볼 수 있는 치료방법으로 사료된다.

• Journal of Microbiology
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• 제45권4호
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• pp.358-363
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• 2007

Multi-drug resistant Pseudomonas aeruginosa has been implicated in a variety of serious therapeutic problems in clinical environments. Among the 968 P. aeruginosa isolates obtained from two hospitals in Daegu, Korea, we acquired 17 isolates that were resistant to all available tested antimicrobial agents, with the exception of colistin (colistin-only sensitive). We characterized the antimicrobial susceptibilities, $metallo-{\beta}-lactamases$, and epidemiological relatedness among the colistin-only sensitive P. aeruginosa isolates. All colistin-only sensitive isolates were positive in the modified Hodge test and imipenem-EDTA synergy test, thereby indicating the production of $metallo-{\beta}-lactamases$. 11 isolates from the secondary hospital and six isolates from the tertiary teaching hospital harbored $bla_{VIM-2}$ and $bla_{IMP-1}$, respectively. The pulsed-field gel electrophoretic analysis of the SpeI-digested DNA from P. aeruginosa isolates indicated that two different clones of colistin-only sensitive P. aeruginosa originated from each hospital, and had spread within the hospital environment. Overall, colistin-only sensitive P. aeruginosa was detected in Korea for the first time, but no pan-drug resistant bacteria were identified. Nationwide surveillance is required in order to monitor the emergence of colistin-only sensitive or pan-drug resistant bacteria.

• 대한수의학회지
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• 제15권1호
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• pp.101-108
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• 1975

The susceptibility of 536 isolates of Staphylococcus and 313 isolates of Streptococcus to a number of chemotherapeutics were studied. These organisms were isolated from bovine mastitis during 1973 and 1974. In addition to this, the rate of multiple resistance of 425 isolates of Staphylococcus and 164 isolates of Streptococcus, isolated in 1974, to the chemotherapeutics was analysed. The results obtained in this work were summerized as follows: 1. Staphylococcus and Streptococcus isolated in 1974 showed a higher resistance, with 3 exceptions of chemotherapeutics, than the isolates of 1973. 2. Staphylococcus isolated in 1973 and 1974 showed a higher susceptibility than Streptococcus. 3. The strains of Staphylococcus resistant to colistin were 39 strains (9.2%), to colistin and sulfisoxazole 33 (7.8%), to streptomycin, kanamycin, colistin and sulfisoxazole 20 (4.7%), and to penicillin, colistin and sulfisoxazole 18 (4.2%). 4. The strains of Streptococcus resistant to colistin were 17 strains (10.4%), to streptomycin, kanamycin, colistin and sulfisoxazole 13 (7.9%), to colistin and sulfisoxazole 11 (6.7%) and to penicillin, colistin and sulfisoxazole 11 (6.7%).

• Toxicological Research
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• 제13권1_2호
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• pp.111-116
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• 1997

In the present study, we investigated the neutralization activity of various antimicrobials against lipopolysaccharide (LPS) as well as interaction between two antimicrobials (enrofioxacin and coilstin) using checkerboard method. The neutralization activity of antimicrobials used in the test was assayed by means of LAL chromogenic test after reaction of LPS with colistin, enorfioxacin, ampicillin, polymyxin B, oxytetracycline, streptomycin, and erythromycin. As the results, the neutralization activity of coltstin and polymixin B had a more stronger than that of tested other antimicrobials. In bacterial culture broth, the best neutralization activity of the antibiotics was also shown to coltstin and polymixin B. Meanwhile, It was shown to have synergism between enorfloxacin and coltstin on the basts of FIC (fractional inhibition concentration). The FIC of enorfioxacin-colistin combinations was 0.50-1.03 to Staphylococcus aureus R-209, 1.03-1.06 to Salmonella typhimurium, 0.75-1.25 to Bordetella Bronchtseptica and 1.02-1.25 to E. coli K88ab. On the basts of the above results, the present study may be of clinical usefulness in the choice of an antibiotic therapy for severe sepsts in animals.