Clinical Use of Colistin in Biofilm-Associated Infections

Advances in Experimental Medicine and Biology
Jaime Lora-TamayoJavier Ariza

Abstract

Biofilm is an adaptive bacterial strategy whereby microorganisms become encased in a complex glycoproteic matrix. The low concentration of oxygen and nutrients in this environment leads to heterogeneous phenotypic changes in the bacteria, with antimicrobial tolerance being of paramount importance. As with other antibiotics, the activity of colistin is impaired by biofilm-embedded bacteria. Therefore, the recommendation for administering high doses in combination with a second drug, indicated for planktonic infections, remains valid in this setting. Notably, colistin has activity against metabolically inactive biofilm-embedded cells located in the inner layers of the biofilm structure. This is opposite and complementary to the activity of other antimicrobials that are able to kill metabolically active cells in the outer layers of the biofilm. Several experimental models have shown a higher activity of colistin when used in combination with other agents, and have reported that this can avoid the emergence of colistin-resistant subpopulations. Most experience of colistin in biofilm-associated infections comes from patients with cystic fibrosis, where the use of nebulized colistin allows high concentrations to reach the site of the...Continue Reading

Citations

Feb 6, 2020·Antimicrobial Agents and Chemotherapy·Fatma Ben JeddouThilo Köhler
Jun 12, 2021·Brazilian Journal of Microbiology : [publication of the Brazilian Society for Microbiology]·Katarzyna ĆwiekAlina Wieliczko
Jul 3, 2021·Antibiotics·Estelle J RamchuranBeatriz G de la Torre

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