Colistin resistance of Acinetobacter baumannii: clinical reports, mechanisms and antimicrobial strategies

J Antimicrob Chemother. 2012 Jul;67(7):1607-15. doi: 10.1093/jac/dks084. Epub 2012 Mar 22.


Colistin is the last resort for treatment of multidrug-resistant Acinetobacter baumannii. Unfortunately, resistance to colistin has been reported all over the world. The highest resistance rate was reported in Asia, followed by Europe. The heteroresistance rate of A. baumannii to colistin is generally higher than the resistance rate. The mechanism of resistance might be loss of lipopolysaccharide or/and the PmrAB two-component system. Pharmacokinetic/pharmacodynamic studies revealed that colistin monotherapy is unable to prevent resistance, and combination therapy might be the best antimicrobial strategy against colistin-resistant A. baumannii. Colistin/rifampicin and colistin/carbapenem are the most studied combinations that showed promising results in vitro, in vivo and in the clinic. New peptides showing good activity against colistin-resistant A. baumannii are also being investigated.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acinetobacter Infections / drug therapy
  • Acinetobacter Infections / epidemiology
  • Acinetobacter Infections / microbiology*
  • Acinetobacter baumannii / drug effects*
  • Anti-Bacterial Agents / pharmacology*
  • Anti-Bacterial Agents / therapeutic use
  • Asia / epidemiology
  • Colistin / pharmacology*
  • Colistin / therapeutic use
  • Drug Resistance, Multiple, Bacterial*
  • Drug Therapy, Combination / methods
  • Europe / epidemiology
  • Humans
  • Prevalence


  • Anti-Bacterial Agents
  • Colistin