{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T09:51:26Z","timestamp":1774432286274,"version":"3.50.1"},"reference-count":70,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2017,11,21]],"date-time":"2017-11-21T00:00:00Z","timestamp":1511222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Acinetobacter baumannii is an important opportunistic nosocomial pathogen often resistant to multiple antibiotics classes. Colistin, an \u201cold\u201d antibiotic, is now considered a last-line treatment option for extremely resistant isolates. In the meantime, resistance to colistin has been reported in clinical A. baumannii strains. Colistin is a cationic peptide that disrupts the outer membrane (OM) of Gram-negative bacteria. Colistin resistance is primarily due to post-translational modification or loss of the lipopolysaccharide (LPS) molecules inserted into the outer leaflet of the OM. LPS modification prevents the binding of polymyxin to the bacterial surface and may lead to alterations in bacterial virulence. Antimicrobial pressure drives the evolution of antimicrobial resistance and resistance is often associated with a reduced bacterial fitness. Therefore, the alterations in LPS may induce changes in the fitness of A. baumannii. However, compensatory mutations in clinical A. baumannii may ameliorate the cost of resistance and may play an important role in the dissemination of colistin-resistant A. baumannii isolates. The focus of this review is to summarize the colistin resistance mechanisms, and understand their impact on the fitness and virulence of bacteria and on the dissemination of colistin-resistant A. baumannii strains.<\/jats:p>","DOI":"10.3390\/antibiotics6040028","type":"journal-article","created":{"date-parts":[[2017,11,21]],"date-time":"2017-11-21T11:23:20Z","timestamp":1511263400000},"page":"28","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":76,"title":["Interplay between Colistin Resistance, Virulence and Fitness in Acinetobacter baumannii"],"prefix":"10.3390","volume":"6","author":[{"given":"Gabriela","family":"Da Silva","sequence":"first","affiliation":[{"name":"Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal"},{"name":"Centre for Neurosciences and Cell Biology, University of Coimbra, 3000-548 Coimbra, Portugal"}]},{"given":"Sara","family":"Domingues","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal"},{"name":"Centre for Neurosciences and Cell Biology, University of Coimbra, 3000-548 Coimbra, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2017,11,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1038\/nrmicro1789","article-title":"An increasing threat in hospitals: Multidrug-resistant Acinetobacter baumannii","volume":"5","author":"Dijkshoorn","year":"2007","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"55","DOI":"10.3389\/fcimb.2017.00055","article-title":"Biology of Acinetobacter baumannii: Pathogenesis, antibiotic resistance mechanisms, and prospective treatment options","volume":"7","author":"Lee","year":"2017","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1128\/CMR.00058-16","article-title":"Clinical and pathophysiological overview of Acinetobacter infections: A century of challenges","volume":"30","author":"Wong","year":"2017","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_4","unstructured":"World Health Organization (2017, October 02). Global Priority List of Antibiotic-Resistant Bacteria to Guide Research, Discovery, and Development of New Antibiotics. Available online: http:\/\/www.who.int\/medicines\/publications\/WHO-PPL-Short_Summary_25Feb-ET_NM_WHO.pdf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1099\/jmm.0.000127","article-title":"Molecular identification of tigecycline- and colistin-resistant carbapenemase-producing Acinetobacter baumannii from a Greek hospital from 2011 to 2013","volume":"64","author":"Mavroidi","year":"2015","journal-title":"J. Med. Microbiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.jhin.2014.02.001","article-title":"Spread of a carbapenem- and colistin-resistant Acinetobacter baumannii ST2 clonal strain causing outbreaks in two Sicilian hospitals","volume":"86","author":"Agodi","year":"2014","journal-title":"J. Hosp. Infect."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1093\/jac\/dks084","article-title":"Colistin resistance of Acinetobacter baumannii: Clinical reports, mechanisms and antimicrobial strategies","volume":"67","author":"Cai","year":"2012","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/S1473-3099(15)00424-7","article-title":"Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: A microbiological and molecular biological study","volume":"16","author":"Liu","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2594","DOI":"10.1128\/AAC.00066-16","article-title":"Occurrence of the plasmid-borne mcr-1 colistin resistance gene in extended-spectrum-beta-lactamase-producing Enterobacteriaceae in river water and imported vegetable samples in Switzerland","volume":"60","author":"Zurfuh","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.ijantimicag.2016.04.008","article-title":"Resistance to colistin: What is the fate for this antibiotic in pig production?","volume":"48","author":"Rhouma","year":"2016","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Xavier, B.B., Lammens, C., Ruhal, R., Kumar-Singh, S., Butaye, P., Goossens, H., and Malhotra-Kumar, S. (2016). Identification of a novel plasmid-mediated colistin-resistance gene, mcr-2, in Escherichia coli, Belgium, June 2016. Euro Surveill., 21.","DOI":"10.2807\/1560-7917.ES.2016.21.27.30280"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e00543-17","DOI":"10.1128\/mBio.00543-17","article-title":"Novel plasmid-mediated colistin resistance gene mcr-3 in Escherichia coli","volume":"8","author":"Yin","year":"2017","journal-title":"MBio"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"30589","DOI":"10.2807\/1560-7917.ES.2017.22.31.30589","article-title":"Novel plasmid-mediated colistin resistance mcr-4 gene in Salmonella and Escherichia coli, Italy 2013, Spain and Belgium, 2015 to 2016","volume":"22","author":"Carattoli","year":"2017","journal-title":"Euro Surveill."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Borowiak, M., Fischer, J., Hammerl, J.A., Hendriksen, R.S., Szabo, I., and Malorny, B. (2017). Identification of a novel transposon-associated phosphoethanolamine transferase gene, mcr-5, conferring colistin resistance in d-tartrate fermenting Salmonella enterica subsp. enterica serovar Paratyphi B. J. Antimicrob. Chemother.","DOI":"10.1093\/jac\/dkx327"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1128\/CMR.00064-16","article-title":"Polymyxins: Antibacterial activity, susceptibility testing, and resistance mechanisms encoded by plasmids or chromosomes","volume":"30","author":"Poirel","year":"2017","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/s11908-017-0596-3","article-title":"Polymyxin resistance in Gram-negative pathogens","volume":"19","author":"Srinivas","year":"2017","journal-title":"Curr. Infect. Dis. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1128\/JB.00906-15","article-title":"Pathogenic Acinetobacter: From the cell surface to infinity and beyond","volume":"198","author":"Weber","year":"2015","journal-title":"J. Bacteriol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Kroger, C., Kary, S.C., Schauer, K., and Cameron, A.D. (2016). Genetic regulation of virulence and antibiotic resistance in Acinetobacter baumannii. Genes (Basel), 8.","DOI":"10.3390\/genes8010012"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1898","DOI":"10.1021\/jm900999h","article-title":"Structure-activity relationships of polymyxin antibiotics","volume":"53","author":"Velkov","year":"2010","journal-title":"J. Med. Chem."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"8856","DOI":"10.1073\/pnas.97.16.8856","article-title":"The role of antimicrobial peptides in animal defenses","volume":"97","author":"Hancock","year":"2000","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1111\/j.1348-0421.2009.00119.x","article-title":"Transepithelial activation of human leukocytes by probiotics and commensal bacteria: Role of Enterobacteriaceae-type endotoxin","volume":"53","author":"Baeuerlein","year":"2009","journal-title":"Microbiol. Immunol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.ijantimicag.2004.10.001","article-title":"Evaluation of colistin as an agent against multi-resistant Gram-negative bacteria","volume":"25","author":"Li","year":"2005","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1038\/ja.2013.111","article-title":"A secondary mode of action of polymyxins against Gram-negative bacteria involves the inhibition of NADH-quinone oxidoreductase activity","volume":"67","author":"Deris","year":"2014","journal-title":"J. Antibiot. (Tokyo)"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1093\/infdis\/jit293","article-title":"Emergence of colistin-resistance in extremely drug-resistant Acinetobacter baumannii containing a novel pmrCAB operon during colistin therapy of wound infections","volume":"208","author":"Lesho","year":"2013","journal-title":"J. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1128\/AAC.01314-12","article-title":"Real-time sequencing to decipher the molecular mechanism of resistance of a clinical pan-drug-resistant Acinetobacter baumannii isolate from Marseille, France","volume":"57","author":"Rolain","year":"2013","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1101\/gr.154328.112","article-title":"Genomic insights into the fate of colistin resistance and Acinetobacter baumannii during patient treatment","volume":"23","author":"Snitkin","year":"2013","journal-title":"Genome Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3628","DOI":"10.1128\/AAC.00284-09","article-title":"Resistance to colistin in Acinetobacter baumannii associated with mutations in the PmrAB two-component system","volume":"53","author":"Adams","year":"2009","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3743","DOI":"10.1128\/AAC.00256-11","article-title":"The PmrCAB operon mediates polymyxin resistance in Acinetobacter baumannii ATCC 17978 and clinical isolates through phosphoethanolamine modification of lipid A","volume":"55","author":"Arroyo","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3370","DOI":"10.1128\/AAC.00079-11","article-title":"Phosphoethanolamine modification of lipid A in colistin-resistant variants of Acinetobacter baumannii mediated by the PmrAB two-component regulatory system","volume":"55","author":"Beceiro","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.ijantimicag.2011.02.008","article-title":"Correlation between overexpression and amino acid substitution of the PmrAB locus and colistin resistance in Acinetobacter baumannii","volume":"37","author":"Park","year":"2011","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"4831","DOI":"10.1128\/AAC.00865-13","article-title":"Unique structural modifications are present in the lipopolysaccharide from colistin-resistant strains of Acinetobacter baumannii","volume":"57","author":"Pelletier","year":"2013","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e00478-15","DOI":"10.1128\/mBio.00478-15","article-title":"Reinforcing lipid A acylation on the cell surface of Acinetobacter baumannii promotes cationic antimicrobial peptide resistance and desiccation survival","volume":"6","author":"Boll","year":"2015","journal-title":"MBio"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3022","DOI":"10.1128\/AAC.01732-10","article-title":"Insertion sequence ISAba11 is involved in colistin resistance and loss of lipopolysaccharide in Acinetobacter baumannii","volume":"55","author":"Moffatt","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"4971","DOI":"10.1128\/AAC.00834-10","article-title":"Colistin resistance in Acinetobacter baumannii is mediated by complete loss of lipopolysaccharide production","volume":"54","author":"Moffatt","year":"2010","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1128\/IAI.00704-12","article-title":"Genetic determinants of intrinsic colistin tolerance in Acinetobacter baumannii","volume":"81","author":"Hood","year":"2013","journal-title":"Infect. Immun."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"953417","DOI":"10.1155\/2014\/953417","article-title":"Prevalence and genetic characterization of carbapenem- and polymyxin-resistant Acinetobacter baumannii isolated from a tertiary hospital in Terengganu, Malaysia","volume":"2014","author":"Lean","year":"2014","journal-title":"ISRN Microbiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1128\/JB.00639-15","article-title":"Characterization of an Acinetobacter baumannii lptD deletion strain: Permeability defects and response to inhibition of lipopolysaccharide and fatty acid biosynthesis","volume":"198","author":"Bojkovic","year":"2015","journal-title":"J. Bacteriol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1128\/IAI.01362-12","article-title":"Lipopolysaccharide-deficient Acinetobacter baumannii shows altered signaling through host Toll-like receptors and increased susceptibility to the host antimicrobial peptide LL-37","volume":"81","author":"Moffatt","year":"2013","journal-title":"Infect. Immun."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"22287","DOI":"10.1038\/srep22287","article-title":"Global metabolic analyses identify key differences in metabolite levels between polymyxin-susceptible and polymyxin-resistant Acinetobacter baumannii","volume":"6","author":"Maifiah","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"8009","DOI":"10.1073\/pnas.0903229106","article-title":"An ABC transport system that maintains lipid asymmetry in the Gram-negative outer membrane","volume":"106","author":"Malinverni","year":"2009","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/0005-2760(74)90213-6","article-title":"Phospholipase A activity in growing Escherichia coli cells","volume":"348","author":"Audet","year":"1974","journal-title":"Biochim. Biophys. Acta"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"28291","DOI":"10.1038\/srep28291","article-title":"The induction and identification of novel colistin resistance mutations in Acinetobacter baumannii and their implications","volume":"6","author":"Riordan","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1128\/AAC.00963-09","article-title":"Acinetobacter baumannii increases tolerance to antibiotics in response to monovalent cations","volume":"54","author":"Hood","year":"2010","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"3215","DOI":"10.1128\/AAC.00248-16","article-title":"Effects of efflux pump inhibitors on colistin resistance in multidrug-resistant Gram-negative bacteria","volume":"60","author":"Ni","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.mib.2003.09.001","article-title":"Persistence of antibiotic resistant bacteria","volume":"6","author":"Andersson","year":"2003","journal-title":"Curr. Opin. Microbiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.3389\/fmicb.2016.01715","article-title":"The effect of colistin resistance-associated mutations on the fitness of Acinetobacter baumannii","volume":"7","author":"Mu","year":"2016","journal-title":"Front. Microbiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1093\/infdis\/jiw402","article-title":"Interplay between antibiotic resistance and virulence during disease promoted by multidrug-resistant bacteria","volume":"215","author":"Geisinger","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1128\/CMR.00059-12","article-title":"Antimicrobial resistance and virulence: A successful or deleterious association in the bacterial world?","volume":"26","author":"Beceiro","year":"2013","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1111\/j.1574-6976.2012.00344.x","article-title":"Acinetobacter baumannii: Human infections, factors contributing to pathogenesis and animal models","volume":"37","author":"McConnell","year":"2013","journal-title":"FEMS Microbiol. Rev."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1111\/2049-632X.12125","article-title":"Acinetobacter baumannii: Evolution of a global pathogen","volume":"71","author":"Antunes","year":"2014","journal-title":"Pathog. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1093\/infdis\/jir475","article-title":"Acinetobacter baumannii resistant to colistin with impaired virulence: A case report from France","volume":"204","author":"Rolain","year":"2011","journal-title":"J. Infect. Dis."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"5120","DOI":"10.1128\/AAC.00700-13","article-title":"Impaired virulence and fitness of a colistin-resistant clinical isolate of Acinetobacter baumannii in a rat model of pneumonia","volume":"57","author":"Hraiech","year":"2013","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1128\/AAC.01439-13","article-title":"Growth retardation, reduced invasiveness, and impaired colistin-mediated cell death associated with colistin resistance development in Acinetobacter baumannii","volume":"58","author":"Pournaras","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1093\/infdis\/jir476","article-title":"Acinetobacter baumannii resistant to colistin alters its antibiotic resistance profile: A case report from Spain","volume":"204","author":"Lepe","year":"2011","journal-title":"J. Infect. Dis."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"4587","DOI":"10.1128\/AAC.00543-13","article-title":"Colistin resistance in a clinical Acinetobacter baumannii strain appearing after colistin treatment: Effect on virulence and bacterial fitness","volume":"57","author":"McConnell","year":"2013","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.jinf.2009.09.004","article-title":"The virulence variability of different Acinetobacter baumannii strains in experimental pneumonia","volume":"60","author":"Eveillard","year":"2010","journal-title":"J. Infect."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.diagmicrobio.2015.03.013","article-title":"Emergence of colistin resistance without loss of fitness and virulence after prolonged colistin administration in a patient with extensively drug-resistant Acinetobacter baumannii","volume":"82","author":"Andini","year":"2015","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1016\/j.ijantimicag.2017.01.031","article-title":"A novel mutation in pmrB mediates colistin resistance during therapy of Acinetobacter baumannii","volume":"49","author":"Dahdouh","year":"2017","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1892","DOI":"10.1128\/AAC.02518-15","article-title":"Colistin-resistant Acinetobacter baumannii clinical strains with deficient biofilm formation","volume":"60","author":"Dafopoulou","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2209","DOI":"10.1093\/jac\/dkv097","article-title":"Retention of virulence following adaptation to colistin in Acinetobacter baumannii reflects the mechanism of resistance","volume":"70","author":"Wand","year":"2015","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1632","DOI":"10.1002\/pmic.200800434","article-title":"The cost of resistance to colistin in Acinetobacter baumannii: A proteomic perspective","volume":"9","author":"Chiva","year":"2009","journal-title":"Proteomics"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1093\/infdis\/jiq086","article-title":"Impaired virulence and In Vivo fitness of colistin-resistant Acinetobacter baumannii","volume":"203","author":"McConnell","year":"2011","journal-title":"J. Infect. Dis."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.ijantimicag.2016.03.010","article-title":"Impaired growth under iron-limiting conditions associated with the acquisition of colistin resistance in Acinetobacter baumannii","volume":"47","author":"Pachon","year":"2016","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1086\/595977","article-title":"Nosocomial outbreak of infection with pan-drug-resistant Acinetobacter baumannii in a tertiary care university hospital","volume":"30","author":"Valencia","year":"2009","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1128\/AAC.01597-13","article-title":"Biological cost of different mechanisms of colistin resistance and their impact on virulence in Acinetobacter baumannii","volume":"58","author":"Beceiro","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e00598-16","DOI":"10.1128\/AAC.00598-16","article-title":"In Vivo fitness adaptations of colistin-resistant Acinetobacter baumannii isolates to oxidative stress","volume":"61","author":"Jones","year":"2017","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"407","DOI":"10.2217\/fmb.11.23","article-title":"Global spread of drug-resistant Acinetobacter baumannii: Molecular epidemiology and management of antimicrobial resistance","volume":"6","author":"Zarrilli","year":"2011","journal-title":"Future Microbiol."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Oikonomou, O., Sarrou, S., Papagiannitsis, C.C., Georgiadou, S., Mantzarlis, K., Zakynthinos, E., Dalekos, G.N., and Petinaki, E. (2015). Rapid dissemination of colistin and carbapenem resistant Acinetobacter baumannii in Central Greece: Mechanisms of resistance, molecular identification and epidemiological data. BMC Infect. Dis., 15.","DOI":"10.1186\/s12879-015-1297-x"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1086\/520658","article-title":"Antibiograms of multidrug-resistant clinical Acinetobacter baumannii: Promising therapeutic options for treatment of infection with colistin-resistant strains","volume":"45","author":"Li","year":"2007","journal-title":"Clin. Infect. Dis."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1086\/533476","article-title":"Increased antimicrobial susceptibility profiles among polymyxin-resistant Acinetobacter baumannii clinical isolates","volume":"46","author":"Mendes","year":"2008","journal-title":"Clin. Infect. Dis."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/6\/4\/28\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:50:31Z","timestamp":1760208631000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/6\/4\/28"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,21]]},"references-count":70,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2017,12]]}},"alternative-id":["antibiotics6040028"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics6040028","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,21]]}}}