{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:56:38Z","timestamp":1785405398340,"version":"3.56.0"},"reference-count":133,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Colistin remains a critical last-line therapeutic option against multidrug-resistant Gram-negative infections; but its utility is threatened increasingly by the global spread resistance determinants. Resistance emerges through two principal genetic pathways: horizontal transmission of\u00a0mcr\u00a0genes enabling rapid interspecies dissemination, and vertical chromosomal mutations facilitating clonal expansion.\nAim: To compare plasmid-mediated and chromosomal colistin resistance mechanisms and examine their clinical significance, epidemiological implications, diagnostic challenges, and surveillance barriers within a One Health framework.\nMethods:\u00a0For this narrative, non-systematic review, searches were conducted in PubMed, MEDLINE, Web of Science, Scopus and African Journals Online (AJOL) to identify studies on colistin resistance, its emergence, clinical implications, and related surveillance and diagnostic barriers.\nResults:\u00a0Several genetic determinants influence colistin susceptibility; notably,\u00a0mcr\u00a0variants and chromosomal mutations in Lipid A modification genes (e.g.,\u00a0pmrA, pmrB\u00a0and\u00a0mgrB) reduce colistin binding and bactericidal activity. In African and other resource-limited settings, limited laboratory infrastructure further complicates detection and surveillance, underscoring the need for context-appropriate diagnostics and antimicrobial stewardship. Collectively, these factors pose major clinical and epidemiological concerns.\nConclusion:\u00a0Although surveillance-driven stewardship may mitigate resistance trends, its effectiveness is constrained by the convergence of colistin and carbapenem resistance, increasing the risk of pan-drug-resistant infections. Rapid field-deployable diagnostics and harmonised global surveillance systems that consider the distinct evolutionary trajectories of plasmid-mediated and chromosomal resistance remain urgently needed.\nWhat this study adds:\u00a0This review highlights the contrasting evolutionary pathways of plasmid-mediated and chromosomal colistin resistance and emphasises the importance of integrated surveillance, diagnostics, and stewardship strategies within a One Health approach.<\/jats:p>","DOI":"10.4102\/ajlm.v15i1.3122","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T13:22:45Z","timestamp":1780665765000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The colistin resistance pandemic: A dual threat from plasmid-encoded mobilised colistin resistance genes and chromosomal mutations"],"prefix":"10.4102","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2814-8205","authenticated-orcid":false,"given":"Muzaheed","family":"Muzaheed","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/038cy8j79","id-type":"ROR","asserted-by":"publisher"}],"name":"Imam Abdulrahman Bin Faisal University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"ref0","unstructured":"World Health Organization Division of Antimicrobial Resistance. Global antibiotic resistance surveillance report 2025 [homepage on the Internet]. Geneva: World Health Organization; 2025 [cited 2025 Nov 15]. Available from: https:\/\/www.who.int\/publications\/i\/item\/9789240116337"},{"key":"ref1","unstructured":"World Health Organization. WHO warns of widespread resistance to common antibiotics worldwide [homepage on the Internet]. Geneva: World Health Organization; 2025 [cited 2025 Nov 15]. Available from: https:\/\/www.who.int\/news\/item\/13-10-2025-who-warns-of-widespread-resistance-to-common-antibiotics-worldwide"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Naghavi M, Vollset SE, Ikuta KS, et al. Global burden of bacterial antimicrobial resistance 1990\u20132021: A systematic analysis with forecasts to 2050. Lancet. 2024;404(10459):1199\u20131226. https:\/\/doi.org\/10.1016\/S0140-6736(24)01867-1","DOI":"10.1016\/S0140-6736(24)01867-1"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Yekani M, Rezaee MA, Beheshtirouy S, et al. Carbapenem resistance in Bacteroides fragilis: A review of molecular mechanisms. Anaerobe. 2022;76:102606. https:\/\/doi.org\/10.1016\/j.anaerobe.2022.102606","DOI":"10.1016\/j.anaerobe.2022.102606"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Lyu C, Zhang Y, Liu X, Wu J, Zhang J. Clinical efficacy and safety of polymyxins based versus non-polymyxins based therapies in the infections caused by carbapenem-resistant Acinetobacter baumannii: A systematic review and meta-analysis. BMC Infect Dis. 2020;20(1):296. https:\/\/doi.org\/10.1186\/s12879-020-05026-2","DOI":"10.1186\/s12879-020-05026-2"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Hait PS, Pawar SK, Patil SR. Colistin insusceptibility in Carbapenem-resistant enterobacteriaceae isolates from a tertiary referral centre. Cureus. 2024;16(10):e71329. https:\/\/doi.org\/10.7759\/cureus.71329","DOI":"10.7759\/cureus.71329"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Gogry FA, Siddiqui MT, Sultan I, Haq QMR. Current update on intrinsic and acquired colistin resistance mechanisms in bacteria. Front Med (Lausanne). 2021;8:677720. https:\/\/doi.org\/10.3389\/fmed.2021.677720","DOI":"10.3389\/fmed.2021.677720"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Mondal AH, Khare K, Saxena P, Debnath P, Mukhopadhyay K, Yadav D. A review on Colistin resistance: An antibiotic of last resort. Microorganisms. 2024;12(4):772. https:\/\/doi.org\/10.3390\/microorganisms12040772","DOI":"10.3390\/microorganisms12040772"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Elnahriry SS, Khalifa HO, Soliman AM, et al. Emergence of plasmid-mediated colistin resistance gene mcr-1 in a clinical Escherichia coli isolate from Egypt. Antimicrob Agents Chemother. 2016;60(5):3249\u20133250. https:\/\/doi.org\/10.1128\/AAC.00269-16","DOI":"10.1128\/AAC.00269-16"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Ngbede EO, Poudel A, Kalalah A, et al. Identification of mobile colistin resistance genes (mcr-1.1, mcr-5 and mcr-8.1) in Enterobacteriaceae and Alcaligenes faecalis of human and animal origin, Nigeria. Int J Antimicrob Agents. 2020;56(3):106108. https:\/\/doi.org\/10.1016\/j.ijantimicag.2020.106108","DOI":"10.1016\/j.ijantimicag.2020.106108"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Coetzee J, Corcoran C, Prentice E, et al. Emergence of plasmid-mediated colistin resistance (MCR-1) among Escherichia coli isolated from South African patients. S Afr Med J. 2016;106(5):449. https:\/\/doi.org\/10.7196\/SAMJ.2016.v106i5.10710","DOI":"10.7196\/SAMJ.2016.v106i5.10710"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Perreten V, Strauss C, Collaud A, Gerber D. Colistin resistance gene mcr-1 in avian-pathogenic Escherichia coli in South Africa. Antimicrob Agents Chemother. 2016;60(7):4414\u20134415. https:\/\/doi.org\/10.1128\/AAC.00548-16","DOI":"10.1128\/AAC.00548-16"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Varma JK, Oppong-Otoo J, Ondoa P, et al. Africa centres for disease control and prevention\u2019s framework for antimicrobial resistance control in Africa. Afr J Lab Med. 2018;7(2):830. https:\/\/doi.org\/10.4102\/ajlm.v7i2.830","DOI":"10.4102\/ajlm.v7i2.830"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Hussein NH, Al-Kadmy IMS, Taha BM, Hussein JD. Mobilized colistin resistance (mcr) genes from 1 to 10: A comprehensive review. Mol Biol Rep. 2021;48(3):2897\u20132907. https:\/\/doi.org\/10.1007\/s11033-021-06307-y","DOI":"10.1007\/s11033-021-06307-y"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Forde BM, Zowawi HM, Harris PNA, et al. Discovery of mcr-1-mediated colistin resistance in a highly virulent Escherichia coli lineage. MSphere. 2018;3(5):e00486\u2013e00518. https:\/\/doi.org\/10.1128\/mSphere.00486-18","DOI":"10.1128\/mSphere.00486-18"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Joshi A, Matange N. Sequence variation in the active site of mobile colistin resistance proteins is evolutionarily accommodated through inter-domain interactions. Biochem J. 2024;481(23):1741\u20131755. https:\/\/doi.org\/10.1042\/BCJ20240373","DOI":"10.1042\/BCJ20240373"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Liu YY, Wang Y, Walsh TR, et al. Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: A microbiological and molecular biological study. Lancet Infect Dis. 2015;16(2):161\u2013168. https:\/\/doi.org\/10.1016\/S1473-3099(15)00424-7","DOI":"10.1016\/S1473-3099(15)00424-7"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Xavier BB, Lammens C, Ruhal R, et al. Identification of a novel plasmid-mediated colistin-resistance gene, mcr-2, in Escherichia coli, Belgium, June 2016. Euro Surveill. 2016;21(27):pii=30280. https:\/\/doi.org\/10.2807\/1560-7917.ES.2016.21.27.30280","DOI":"10.2807\/1560-7917.ES.2016.21.27.30280"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Yin W, Li H, Shen Y, et al. Novel plasmid-mediated colistin resistance gene mcr-3 in Escherichia coli. mBio. 2017;8(3):e00543\u201317. https:\/\/doi.org\/10.1128\/mBio.00543-17","DOI":"10.1128\/mBio.00543-17"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Carattoli A, Villa L, Feudi C, et al. Novel plasmid-mediated colistin resistance mcr-4 gene in Salmonella and Escherichia coli, Italy 2013, Spain and Belgium, 2015 to 2016. Euro Surveill. 2017;22(31):pii=30589. https:\/\/doi.org\/10.2807\/1560-7917.ES.2017.22.31.30589","DOI":"10.2807\/1560-7917.ES.2017.22.31.30589"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Borowiak M, Fischer J, Hammerl JA, Hendriksen RS, Szabo I, Malorny B. 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. 2017;72(12):3317\u20133324. https:\/\/doi.org\/10.1093\/jac\/dkx327","DOI":"10.1093\/jac\/dkx327"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"AbuOun M, Stubberfield EJ, Duggett NA, et al. mcr-1 and mcr-2 (mcr-6.1) variant genes identified in Moraxella species isolated from pigs in Great Britain from 2014 to 2015. J Antimicrob Chemother. 2018;73(10):2904. https:\/\/doi.org\/10.1093\/jac\/dky272","DOI":"10.1093\/jac\/dky272"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Yang YQ, Li YX, Lei CW, Zhang AY, Wang HN. Novel plasmid-mediated colistin resistance gene mcr-7.1 in Klebsiella pneumoniae. J Antimicrob Chemoth. 2018;73(7):1791\u20131795. https:\/\/doi.org\/10.1093\/jac\/dky111","DOI":"10.1093\/jac\/dky111"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Wang X, Wang Y, Wang Y, et al. Emergence of a novel mobile colistin resistance gene, mcr-8, in NDM-producing Klebsiella pneumoniae. Emerg Microbes Infect. 2018;7(1):1\u20139. https:\/\/doi.org\/10.1038\/s41426-018-0124-z","DOI":"10.1038\/s41426-018-0124-z"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Carroll LM, Gaballa A, Guldimann C, Sullivan G, Henderson LO, Wiedmann M. Identification of novel mobilized colistin resistance gene mcr-9 in a multidrug-resistant, colistin-susceptible Salmonella enterica serotype typhimurium isolate. mBio. 2019;10(3):e00853\u201319. https:\/\/doi.org\/10.1128\/mBio.00853-19","DOI":"10.1128\/mBio.00853-19"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Wang C, Feng Y, Liu L, Wei L, Kang M, Zong Z. Identification of novel mobile colistin resistance gene mcr-10. Emerg Microbes Infect. 2020;9(1):508\u2013516. https:\/\/doi.org\/10.1080\/22221751.2020.1732231","DOI":"10.1080\/22221751.2020.1732231"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Snesrud E, McGann P, Chandler M. The birth and demise of the IS Apl1-mcr-1-IS Apl1 composite transposon: The vehicle for transferable colistin resistance. mBio. 2018;9(1):e02381\u2013e02417. https:\/\/doi.org\/10.1128\/mBio.02381-17","DOI":"10.1128\/mBio.02381-17"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Lin YC, Kuroda M, Suzuki S, Mu JJ. Emergence of the mcr-1 colistin resistance gene in extended-spectrum \u03b2-lactamase-producing Klebsiella pneumoniae in Taiwan. J Glob Antimicrob Resist. 2021:278\u2013284. https:\/\/doi.org\/10.1016\/j.jgar.2020.12.024","DOI":"10.1016\/j.jgar.2020.12.024"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Ikhimiukor OO, Montoya-Giraldo M, Souza SSR, et al. Dissemination dynamics of colistin resistance genes mcr-9 and mcr-10 across diverse Inc plasmid backbones. Commun Med (Lond). 2025;5(1):399. https:\/\/doi.org\/10.1038\/s43856-025-01109-w","DOI":"10.1038\/s43856-025-01109-w"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Roy RK, Biswas R, Roy A, et al. Overview of the breadth of bacterial resistance development within the framework of antibiotics and antimicrobial peptides. Microbe. 2025;8:100477. https:\/\/doi.org\/10.1016\/j.microb.2025.100477","DOI":"10.1016\/j.microb.2025.100477"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Zelendova M, Papagiannitsis CC, Sismova P, et al. Plasmid-mediated colistin resistance among human clinical Enterobacterales isolates: National surveillance in the Czech Republic. Front Microbiol. 2023;14:1147846. https:\/\/doi.org\/10.3389\/fmicb.2023.1147846","DOI":"10.3389\/fmicb.2023.1147846"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Karim MdR, Zakaria Z, Hassan L, Faiz NM, Ahmad NI. Antimicrobial resistance profiles and co-existence of multiple antimicrobial resistance genes in mcr-harbouring colistin-resistant Enterobacteriaceae isolates recovered from poultry and poultry meats in Malaysia. Antibiotics. 2023;12(6):1060. https:\/\/doi.org\/10.3390\/antibiotics12061060","DOI":"10.3390\/antibiotics12061060"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Dos Santos LDR, Furlan JPR, Ramos MS, Gallo IFL, De Freitas LVP, Stehling EG. Co-occurrence of mcr-1, mcr-3, mcr-7 and clinically relevant antimicrobial resistance genes in environmental and fecal samples. Arch Microbiol. 2020;202(7):1795\u20131800. https:\/\/doi.org\/10.1007\/s00203-020-01890-3","DOI":"10.1007\/s00203-020-01890-3"},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"Munzhedzi M, Chigome A, Miljkovi\u0107 N, et al. Antibiotic shortages among public sector hospitals across sub-Saharan Africa: A protocol for an electronic survey to gain understanding. Adv Hum Biol. 2025;15(4):579\u201385. https:\/\/doi.org\/10.4103\/aihb.aihb_175_25","DOI":"10.4103\/aihb.aihb_175_25"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Shafiq N, Pandey AK, Malhotra S, et al. Shortage of essential antimicrobials: A major challenge to global health security. BMJ Glob Health. 2021;6(11):e006961. https:\/\/doi.org\/10.1136\/bmjgh-2021-006961","DOI":"10.1136\/bmjgh-2021-006961"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Bastidas-Caldes C, De Waard JH, Salgado MS, et al. Worldwide prevalence of mcr-mediated colistin-resistance Escherichia coli in isolates of clinical samples, healthy humans, and livestock \u2013 A systematic review and meta-analysis. Pathogens. 2022;11(6):659. https:\/\/doi.org\/10.3390\/pathogens11060659","DOI":"10.3390\/pathogens11060659"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Khanawapee A, Kerdsin A, Chopjitt P, et al. Distribution and molecular characterization of Escherichia coli harboring mcr genes isolated from slaughtered pigs in Thailand. Microb Drug Resist. 2020.;27(7):971\u2013979. https:\/\/doi.org\/10.1089\/mdr.2020.0242","DOI":"10.1089\/mdr.2020.0242"},{"key":"ref37","doi-asserted-by":"crossref","unstructured":"Garc\u00eda V, Garc\u00eda-Meni\u00f1o I, Mora A, et al. Co-occurrence of mcr-1, mcr-4 and mcr-5 genes in multidrug-resistant ST10 Enterotoxigenic and Shiga toxin-producing Escherichia coli in Spain (2006\u20132017). Int J Antimicrob Agents. 2018;52(1):104\u2013108. https:\/\/doi.org\/10.1016\/j.ijantimicag.2018.03.022","DOI":"10.1016\/j.ijantimicag.2018.03.022"},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"Hern\u00e1ndez M, Iglesias MR, Rodr\u00edguez-L\u00e1zaro D, et al. Co-occurrence of colistin-resistance genes mcr-1 and mcr-3 among multidrug-resistant Escherichia coli isolated from cattle, Spain, September 2015. Euro Surveill. 2017;22(31):pii=30586. https:\/\/doi.org\/10.2807\/1560-7917.ES.2017.22.31.30586","DOI":"10.2807\/1560-7917.ES.2017.22.31.30586"},{"key":"ref39","doi-asserted-by":"crossref","unstructured":"Anyanwu MU, Jaja IF, Oguttu JW, Jaja CJ, Chah KF, Shoyinka VS. Is Africa ready for mobile colistin resistance threat? Infect Ecol Epidemiol. 2021;11(1):1962781. https:\/\/doi.org\/10.1080\/20008686.2021.1962781","DOI":"10.1080\/20008686.2021.1962781"},{"key":"ref40","doi-asserted-by":"crossref","unstructured":"Mendes Oliveira VR, Paiva MC, Lima WG. Plasmid-mediated colistin resistance in Latin America and Caribbean: A systematic review. Travel Med Infect Dis. 2019;31:101459. https:\/\/doi.org\/10.1016\/j.tmaid.2019.07.015","DOI":"10.1016\/j.tmaid.2019.07.015"},{"key":"ref41","doi-asserted-by":"crossref","unstructured":"Zhang Y, Kuang X, Liu J, et al. Identification of the plasmid-mediated colistin resistance gene mcr-1 in Escherichia coli isolates from migratory birds in Guangdong, China. Front Microbiol. 2021;12:755233. https:\/\/doi.org\/10.3389\/fmicb.2021.755233","DOI":"10.3389\/fmicb.2021.755233"},{"key":"ref42","doi-asserted-by":"crossref","unstructured":"Brunelli RC, De Jesus Carvalho Baptista TV, De Oliveira Nithack Marques M, et al. Widespread occurrence of mobile colistin resistance genes in Brazilian marine environments. Ocean Microbiol. 2025;1(1):3. https:\/\/doi.org\/10.1186\/s44375-025-00003-z","DOI":"10.1186\/s44375-025-00003-z"},{"key":"ref43","doi-asserted-by":"crossref","unstructured":"Berrazeg M, Hadjadj L, Ayad A, Drissi M, Rolain JM. First detected human case in Algeria of mcr-1 plasmid-mediated colistin resistance in a 2011 Escherichia coli isolate. Antimicrob Agents Chemother. 2016;60(11):6996\u20136697. https:\/\/doi.org\/10.1128\/AAC.01117-16","DOI":"10.1128\/AAC.01117-16"},{"key":"ref44","doi-asserted-by":"crossref","unstructured":"Ferjani S, Maamar E, Ferjani A, et al. Tunisian multicenter study on the prevalence of colistin resistance in clinical isolates of gram negative bacilli: Emergence of Escherichia coli harbouring the mcr-1 Gene. Antibiotics. 2022;11(10):1390. https:\/\/doi.org\/10.3390\/antibiotics11101390","DOI":"10.3390\/antibiotics11101390"},{"key":"ref45","doi-asserted-by":"crossref","unstructured":"Anyanwu MU, Okpala COR, Chah KF, Shoyinka VS. Prevalence and traits of mobile colistin resistance gene harbouring isolates from different ecosystems in Africa. BioMed Res Int. 2021;2021(1):6630379. https:\/\/doi.org\/10.1155\/2021\/6630379","DOI":"10.1155\/2021\/6630379"},{"key":"ref46","doi-asserted-by":"crossref","unstructured":"Kimera ZI, Mshana SE, Rweyemamu MM, Mboera LEG, Matee MIN. Antimicrobial use and resistance in food-producing animals and the environment: An African perspective. Antimicrob Resist Infect Control. 2020;9(1):37. https:\/\/doi.org\/10.1186\/s13756-020-0697-x","DOI":"10.1186\/s13756-020-0697-x"},{"key":"ref47","doi-asserted-by":"crossref","unstructured":"Odey TOJ, Tanimowo WO, Afolabi KO, Jahid IK, Reuben RC. Antimicrobial use and resistance in food animal production: Food safety and associated concerns in sub-Saharan Africa. Int Microbiol. 2023;27(1):1\u201323. https:\/\/doi.org\/10.1007\/s10123-023-00462-x","DOI":"10.1007\/s10123-023-00462-x"},{"key":"ref48","doi-asserted-by":"crossref","unstructured":"Osisiogu EU, Mahmoud FC, Waqas FB, Singh B, Feglo PK, Duedu KO. Environmental mediation of colistin resistance in the African context. A systematic scoping review. J Glob Antimicrob Resist. 2024;41:39\u201343. https:\/\/doi.org\/10.1016\/j.jgar.2024.12.002","DOI":"10.1016\/j.jgar.2024.12.002"},{"key":"ref49","doi-asserted-by":"crossref","unstructured":"Andrade FF, Silva D, Rodrigues A, Pina-Vaz C. Colistin update on its mechanism of action and resistance, present and future challenges. Microorganisms. 2020;8(11):1716. https:\/\/doi.org\/10.3390\/microorganisms8111716","DOI":"10.3390\/microorganisms8111716"},{"key":"ref50","doi-asserted-by":"crossref","unstructured":"Ly NS, Yang J, Bulitta JB, Tsuji BT. Impact of two-component regulatory systems PhoP-PhoQ and PmrA-PmrB on colistin pharmacodynamics in Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2012;56(6):3453\u20133456. https:\/\/doi.org\/10.1128\/AAC.06380-11","DOI":"10.1128\/AAC.06380-11"},{"key":"ref51","doi-asserted-by":"crossref","unstructured":"Kim S, Woo JH, Kim N, et al. Characterization of chromosome-mediated colistin resistance in Escherichia coli isolates from livestock in Korea. Infect Drug Resist. 2019;12:3291\u20133299. https:\/\/doi.org\/10.2147\/IDR.S225383","DOI":"10.2147\/IDR.S225383"},{"key":"ref52","doi-asserted-by":"crossref","unstructured":"Cheng YH, Lin TL, Lin YT, Wang JT. A putative RND-type efflux pump, H239_3064, contributes to colistin resistance through CrrB in Klebsiella pneumoniae. J Antimicrob Chemother. 2018;73(6):1509\u20131516. https:\/\/doi.org\/10.1093\/jac\/dky054","DOI":"10.1093\/jac\/dky054"},{"key":"ref53","doi-asserted-by":"crossref","unstructured":"Aghapour Z, Gholizadeh P, Ganbarov K, et al. Molecular mechanisms related to colistin resistance in Enterobacteriaceae. Infect Drug Resist. 2019;12:965\u2013975. https:\/\/doi.org\/10.2147\/IDR.S199844","DOI":"10.2147\/IDR.S199844"},{"key":"ref54","doi-asserted-by":"crossref","unstructured":"Bray AS, Smith RD, Hudson AW, et al. MgrB-dependent colistin resistance in Klebsiella pneumoniae is associated with an increase in host-to-host transmission. MBio. 2022;13(2):e0359521. https:\/\/doi.org\/10.1128\/mbio.03595-21","DOI":"10.1128\/mbio.03595-21"},{"key":"ref55","doi-asserted-by":"crossref","unstructured":"Pitt ME, Elliott AG, Cao MD, et al. Multifactorial chromosomal variants regulate polymyxin resistance in extensively drug-resistant Klebsiella pneumoniae. Microb Genom. 2018;4(3):e000158. https:\/\/doi.org\/10.1099\/mgen.0.000158","DOI":"10.1099\/mgen.0.000158"},{"key":"ref56","doi-asserted-by":"crossref","unstructured":"Pitt ME, Cao MD, Butler MS, et al. Octapeptin C4 and polymyxin resistance occur via distinct pathways in an epidemic XDR Klebsiella pneumoniae ST258 isolate. J Antimicrob Chemother. 2019;74(3):582\u2013593. https:\/\/doi.org\/10.1093\/jac\/dky458","DOI":"10.1093\/jac\/dky458"},{"key":"ref57","doi-asserted-by":"crossref","unstructured":"Sancak B, K\u0131rba\u015f E, Ari O, Durmaz R. Genomic characterization of colistin heteroresistance in Acinetobacter baumannii: Evidence for lpxD deletion and collateral sensitivity. J Antimicrob Chemother. 2026;81(4):dkag076. https:\/\/doi.org\/10.1093\/jac\/dkag076","DOI":"10.1093\/jac\/dkag076"},{"key":"ref58","doi-asserted-by":"crossref","unstructured":"Carretero-Ledesma M, Garc\u00eda-Quintanilla M, Mart\u00edn-Pe\u00f1a R, Pulido MR, Pach\u00f3n J, McConnell MJ. Phenotypic changes associated with colistin resistance due to lipopolysaccharide loss in Acinetobacter baumannii. Virulence. 2018;9(1):930\u2013942. https:\/\/doi.org\/10.1080\/21505594.2018.1460187","DOI":"10.1080\/21505594.2018.1460187"},{"key":"ref59","doi-asserted-by":"crossref","unstructured":"Huang S, Wang S, Li Y, et al. Prevalence and transmission of mobilized colistin resistance (mcr-1) gene positive Escherichia coli in healthy rural residents in Shandong province, China. Microbiol Res. 2021;253:126881. https:\/\/doi.org\/10.1016\/j.micres.2021.126881","DOI":"10.1016\/j.micres.2021.126881"},{"key":"ref60","doi-asserted-by":"crossref","unstructured":"Yamaguchi T, Kawahara R, Hamamoto K, et al. High prevalence of colistin-resistant Escherichia coli with chromosomally carried mcr-1 in healthy residents in Vietnam. mSphere. 2020;5(2):e00117\u2013e00120. https:\/\/doi.org\/10.1128\/mSphere.00117-20","DOI":"10.1128\/mSphere.00117-20"},{"key":"ref61","doi-asserted-by":"crossref","unstructured":"An T, Cai Y, Li G, et al. Prevalence and transmission risk of colistin and multidrug resistance in long-distance coastal aquaculture. ISME Commun. 2023;3(1):119. https:\/\/doi.org\/10.1038\/s43705-023-00321-w","DOI":"10.1038\/s43705-023-00321-w"},{"key":"ref62","doi-asserted-by":"crossref","unstructured":"Lee S, An JU, Kim WH, Yi S, Lee J, Cho S. Different threats posed by two major mobilized colistin resistance genes \u2013 mcr-1.1 and mcr-3.1 \u2013 Revealed through comparative genomic analysis. J Glob Antimicrob Resist. 2023;32:50\u201357. https:\/\/doi.org\/10.1016\/j.jgar.2022.12.007","DOI":"10.1016\/j.jgar.2022.12.007"},{"key":"ref63","doi-asserted-by":"crossref","unstructured":"Zhang B, Yu B, Zhou W, et al. Mobile plasmid mediated transition from colistin-sensitive to resistant phenotype in Klebsiella pneumoniae. Front Microbiol. 2021;12:619369. https:\/\/doi.org\/10.3389\/fmicb.2021.619369","DOI":"10.3389\/fmicb.2021.619369"},{"key":"ref64","doi-asserted-by":"crossref","unstructured":"Otter JA, Doumith M, Davies F, et al. Emergence and clonal spread of colistin resistance due to multiple mutational mechanisms in carbapenemase-producing Klebsiella pneumoniae in London. Sci Rep. 2017;7(1):12711. https:\/\/doi.org\/10.1038\/s41598-017-12637-4","DOI":"10.1038\/s41598-017-12637-4"},{"key":"ref65","doi-asserted-by":"crossref","unstructured":"Rocha VFD, Barbosa MS, Leal HF, et al. Prolonged outbreak of carbapenem and colistin-resistant Klebsiella pneumoniae at a large tertiary hospital in Brazil. Front Microbiol. 2022;13:831770. https:\/\/doi.org\/10.3389\/fmicb.2022.831770","DOI":"10.3389\/fmicb.2022.831770"},{"key":"ref66","doi-asserted-by":"crossref","unstructured":"Chen X, Jiang Z, Chen R, et al. Nosocomial outbreak of colistin-resistant, carbapenemase-producing Klebsiella pneumoniae ST11 in a medical intensive care unit. J Glob Antimicrob Resist. 2024;36:436\u2013443. https:\/\/doi.org\/10.1016\/j.jgar.2023.10.013","DOI":"10.1016\/j.jgar.2023.10.013"},{"key":"ref67","doi-asserted-by":"crossref","unstructured":"Kaye KS, Marchaim D, Thamlikitkul V, et al. Colistin monotherapy versus combination therapy for carbapenem-resistant organisms. NEJM Evid. 2022;2(1):EVIDoa2200131. https:\/\/doi.org\/10.1056\/EVIDoa2200131","DOI":"10.1056\/EVIDoa2200131"},{"key":"ref68","doi-asserted-by":"crossref","unstructured":"Sharma R, Yeshwante S, Bui NM, et al. A novel role for colistin as an efflux pump inhibitor in multidrug-resistant Klebsiella pneumoniae. Sci Rep. 2025;15(1):34612. https:\/\/doi.org\/10.1038\/s41598-025-18206-4","DOI":"10.1038\/s41598-025-18206-4"},{"key":"ref69","doi-asserted-by":"crossref","unstructured":"Petrosillo N, Taglietti F, Granata G. Treatment options for colistin resistant Klebsiella pneumoniae: Present and future. J Clin Med. 2019;8(7):934. https:\/\/doi.org\/10.3390\/jcm8070934","DOI":"10.3390\/jcm8070934"},{"key":"ref70","doi-asserted-by":"crossref","unstructured":"Makled AF, Ali SAM, Mahmoud AB, et al. Colistin resistance among Enterobacterales isolates: Underlying mechanisms and alternative treatment options. J Pure Appl Microbiol. 2023;17(4):2263\u20132280. https:\/\/doi.org\/10.22207\/JPAM.17.4.24","DOI":"10.22207\/JPAM.17.4.24"},{"key":"ref71","doi-asserted-by":"crossref","unstructured":"Sharma J, Sharma D, Singh A, Sunita K. Colistin resistance and management of drug resistant infections. Can J Infect Dis Med Microbiol. 2022;2022:4315030. https:\/\/doi.org\/10.1155\/2022\/4315030","DOI":"10.1155\/2022\/4315030"},{"key":"ref72","doi-asserted-by":"crossref","unstructured":"Khoshbakht R, Panahi S, Neshani A, Ghavidel M, Ghazvini K. Novel approaches to overcome colistin resistance in Acinetobacter baumannii: Exploring quorum quenching as a potential solution. Microb Pathog. 2023;182:106264. https:\/\/doi.org\/10.1016\/j.micpath.2023.106264","DOI":"10.1016\/j.micpath.2023.106264"},{"key":"ref73","doi-asserted-by":"crossref","unstructured":"Veeraraghavan B, Pragasam AK, Bakthavatchalam YD, Anandan S, Swaminathan S, Sundaram B. Colistin-sparing approaches with newer antimicrobials to treat carbapenem-resistant organisms: Current evidence and future prospects. Indian J Med Microbiol. 2019;37(1):72\u201390. https:\/\/doi.org\/10.4103\/ijmm.IJMM_19_215","DOI":"10.4103\/ijmm.IJMM_19_215"},{"key":"ref74","doi-asserted-by":"crossref","unstructured":"Choudhary C, Kumar V, Vardhan G, Kumar A, Dhamija P. Combating carbapenem-resistant organisms with colistin-sparing regimens. Indian J Physiol Pharmacol. 2025;69(3):203\u2013210. https:\/\/doi.org\/10.25259\/IJPP_356_2024","DOI":"10.25259\/IJPP_356_2024"},{"key":"ref75","doi-asserted-by":"crossref","unstructured":"Liu J, Shu Y, Zhu F, et al. Comparative efficacy and safety of combination therapy with high-dose sulbactam or colistin with additional antibacterial agents for multiple drug-resistant and extensively drug-resistant Acinetobacter baumannii infections: A systematic review and network meta-analysis. J Glob Antimicrob Resist. 2021;24:136\u2013147. https:\/\/doi.org\/10.1016\/j.jgar.2020.08.021","DOI":"10.1016\/j.jgar.2020.08.021"},{"key":"ref76","doi-asserted-by":"crossref","unstructured":"Kmiecikowski P, Gabriel A, Depka D, Bogiel T. Salvage therapy against infections of MDR Acinetobacter baumannii achieved by synergistic effect of colistin-containing therapies \u2013 Preliminary study. Microorganisms. 2025;13(6):1206. https:\/\/doi.org\/10.3390\/microorganisms13061206","DOI":"10.3390\/microorganisms13061206"},{"key":"ref77","doi-asserted-by":"crossref","unstructured":"Karaaslan E, Oyardi O, Dosler S. Enhancing colistin efficacy with combination therapies for multidrug-resistant P. aeruginosa and A. baumannii isolates. Future Microbiol. 2025;20(7\u20139):523\u2013531. https:\/\/doi.org\/10.1080\/17460913.2025.2490377","DOI":"10.1080\/17460913.2025.2490377"},{"key":"ref78","doi-asserted-by":"crossref","unstructured":"Park HJ, Cho JH, Kim HJ, Han SH, Jeong SH, Byun MK. Colistin monotherapy versus colistin\/rifampicin combination therapy in pneumonia caused by colistin-resistant Acinetobacter baumannii: A randomised controlled trial. J Glob Antimicrob Resist. 2019;17:66\u201371. https:\/\/doi.org\/10.1016\/j.jgar.2018.11.016","DOI":"10.1016\/j.jgar.2018.11.016"},{"key":"ref79","doi-asserted-by":"crossref","unstructured":"Witherell KS, Price J, Bandaranayake AD, Olson J, Call DR. Circumventing colistin resistance by combining colistin and antimicrobial peptides to kill colistin-resistant and multidrug-resistant Gram-negative bacteria. J Glob Antimicrob Resist. 2020;22:706\u2013712. https:\/\/doi.org\/10.1016\/j.jgar.2020.05.013","DOI":"10.1016\/j.jgar.2020.05.013"},{"key":"ref80","doi-asserted-by":"crossref","unstructured":"Shein AMS, Wannigama DL, Higgins PG, et al. Novel colistin-EDTA combination for successful eradication of colistin-resistant Klebsiella pneumoniae catheter-related biofilm infections. Sci Rep. 2021;11(1):21676. https:\/\/doi.org\/10.1038\/s41598-021-01052-5","DOI":"10.1038\/s41598-021-01052-5"},{"key":"ref81","doi-asserted-by":"crossref","unstructured":"Patteson JB, Putz AT, Tao L, et al. Biosynthesis of fluopsin C, a copper-containing antibiotic from Pseudomonas aeruginosa. Science. 2021;374(6571):1005\u20131009. https:\/\/doi.org\/10.1126\/science.abj6749","DOI":"10.1126\/science.abj6749"},{"key":"ref82","doi-asserted-by":"crossref","unstructured":"Afonso L, Grzegorczyk KG, Salom\u00e3o JM, et al. Fluopsin C promotes biofilm removal of XDR Acinetobacter baumannii and presents an additive effect with polymyxin B on planktonic cells. Antibiotics (Basel). 2024;13(9):875. https:\/\/doi.org\/10.3390\/antibiotics13090875","DOI":"10.3390\/antibiotics13090875"},{"key":"ref83","doi-asserted-by":"crossref","unstructured":"Goutam J, Kharwar RN, Tiwari VK, Singh R, Sharma D. Efficient production of the potent antimicrobial metabolite \u2018Terrein\u2019 from the fungus Aspergillus terreus. Nat Prod Commun. 2020;15(3):1934578X20912863. https:\/\/doi.org\/10.1177\/1934578X20912863","DOI":"10.1177\/1934578X20912863"},{"key":"ref84","doi-asserted-by":"crossref","unstructured":"Ayerbe-Algaba R, Gil-Marqu\u00e9s ML, Jim\u00e9nez-Mej\u00edas ME, et al. Synergistic activity of niclosamide in combination with colistin against colistin-susceptible and colistin-resistant Acinetobacter baumannii and Klebsiella pneumoniae. Front Cell Infect Microbiol. 2018;8:348. https:\/\/doi.org\/10.3389\/fcimb.2018.00348","DOI":"10.3389\/fcimb.2018.00348"},{"key":"ref85","doi-asserted-by":"crossref","unstructured":"Khambhati K, Bhattacharjee G, Gohil N, et al. Phage engineering and phage-assisted CRISPR-Cas delivery to combat multidrug-resistant pathogens. Bioeng Transl Med. 2023;8(2):e10381. https:\/\/doi.org\/10.1002\/btm2.10381","DOI":"10.1002\/btm2.10381"},{"key":"ref86","doi-asserted-by":"crossref","unstructured":"Lowe M, Singh-Moodley A, Ismail H, et al. Molecular characterisation of Acinetobacter baumannii isolates from bloodstream infections in a tertiary-level hospital in South Africa. Front Microbiol. 2022;13. https:\/\/doi.org\/10.3389\/fmicb.2022.863129","DOI":"10.3389\/fmicb.2022.863129"},{"key":"ref87","doi-asserted-by":"crossref","unstructured":"Lee YT, Sun JR, Wang YC, et al. Multicentre study of risk factors for mortality in patients with Acinetobacter bacteraemia receiving colistin treatment. Int J Antimicrob Agents. 2020;55(6):105956. https:\/\/doi.org\/10.1016\/j.ijantimicag.2020.105956","DOI":"10.1016\/j.ijantimicag.2020.105956"},{"key":"ref88","doi-asserted-by":"crossref","unstructured":"Alkofide H, Alhammad A, Alruwaili A, et al. Multidrug-resistant and extensively drug-resistant Enterobacteriaceae: Prevalence, treatments, and outcomes: A retrospective cohort study. Res Sq. 2020:rs.3.rs-75467. https:\/\/doi.org\/10.21203\/rs.3.rs-75467\/v1","DOI":"10.21203\/rs.3.rs-75467\/v1"},{"key":"ref89","doi-asserted-by":"crossref","unstructured":"Panigrahi K, Pathi BK, Poddar N, et al. Colistin resistance among multi-drug resistant Gram-negative bacterial isolates from different clinical samples of ICU patients: Prevalence and clinical outcomes. Cureus. 2022;14(8):e28317. https:\/\/doi.org\/10.7759\/cureus.28317","DOI":"10.7759\/cureus.28317"},{"key":"ref90","doi-asserted-by":"crossref","unstructured":"Semet C, Efe K, Akal\u0131n H, et al. Outcome of carbapenem or colistin resistant Klebsiella pneumoniae bacteremia in the intensive care unit. Sci Rep. 2024;14(1):25805. https:\/\/doi.org\/10.1038\/s41598-024-73786-x","DOI":"10.1038\/s41598-024-73786-x"},{"key":"ref91","doi-asserted-by":"crossref","unstructured":"Shibi S, Shobana S, Sanjai R. P-1366. Outcome of 10 patients with colistin-resistant Gram-negative isolates in a tertiary care hospital in South India. Open Forum Infect Dis. 2025;12(suppl 1):S892. https:\/\/doi.org\/10.1093\/ofid\/ofae631.1543","DOI":"10.1093\/ofid\/ofae631.1543"},{"key":"ref92","doi-asserted-by":"crossref","unstructured":"Kon H, Hameir A, Nutman A, et al. Prevalence and clinical consequences of colistin heteroresistance and evolution into full resistance in carbapenem-resistant Acinetobacter baumannii. Microbiol Spectr. 2023;11(3):e0509322. https:\/\/doi.org\/10.1128\/spectrum.05093-22","DOI":"10.1128\/spectrum.05093-22"},{"key":"ref93","doi-asserted-by":"crossref","unstructured":"Kaur A, Gandra S, Gupta P, et al. Clinical outcome of dual colistin- and carbapenem-resistant Klebsiella pneumoniae bloodstream infections: A single-center retrospective study of 75 cases in India. Am J Infect Control. 2017;45(11):1289\u20131291. https:\/\/doi.org\/10.1016\/j.ajic.2017.06.028","DOI":"10.1016\/j.ajic.2017.06.028"},{"key":"ref94","doi-asserted-by":"crossref","unstructured":"Diwane D, Rajhans PA, Jog SA, Dalvi M. Study of colistin resistant gram negative organism in hospitalized patients: A retrospective study. Indian J Crit Care Med. 2024;28(3):286\u2013289. https:\/\/doi.org\/10.5005\/jp-journals-10071-24658","DOI":"10.5005\/jp-journals-10071-24658"},{"key":"ref95","doi-asserted-by":"crossref","unstructured":"Kanaujia R, Jamir I, Arora N, et al. Risk factors and clinical outcomes in patients with colistin-resistant Klebsiella pneumoniae bloodstream infection: A retrospective analysis. Indian J Med Microbiol. 2025;56:100882. https:\/\/doi.org\/10.1016\/j.ijmmb.2025.100882","DOI":"10.1016\/j.ijmmb.2025.100882"},{"key":"ref96","doi-asserted-by":"crossref","unstructured":"Gajic I, Kabic J, Kekic D, et al. Antimicrobial susceptibility testing: A comprehensive review of currently used methods. Antibiotics. 2022;11(4):427. https:\/\/doi.org\/10.3390\/antibiotics11040427","DOI":"10.3390\/antibiotics11040427"},{"key":"ref97","unstructured":"Clinical and Laboratory Standards Institute. M100: Performance standards for antimicrobial susceptibility testing. 35th ed. [homepage on the Internet]. Wayne (PA): CLSI; 2025 [cited 2025 Nov 15]. Available from: https:\/\/clsi.org\/shop\/standards\/m100\/"},{"key":"ref98","unstructured":"The European Committee on Antimicrobial Susceptibility Testing. EUCAST reading guide for broth microdilution, version 5.0, January 2024 [homepage on the Internet]. 2024 [cited 2025 Nov 15]. Available from: https:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/MIC_testing\/Reading_guide_BMD_v_5.0_2024.pdf"},{"key":"ref99","doi-asserted-by":"crossref","unstructured":"Kazaz I, Karaman GC, Karakus H, Kaya S, Hosbul T. Evaluation of colistin susceptibility by four phenotypic methods compared to broth microdilution in multidrug-resistant Klebsiella pneumoniae. BMC Microbiol. 2025;25(1):415. https:\/\/doi.org\/10.1186\/s12866-025-04121-1","DOI":"10.1186\/s12866-025-04121-1"},{"key":"ref100","doi-asserted-by":"crossref","unstructured":"Przybysz SM, Correa-Martinez C, K\u00f6ck R, Becker K, Schaumburg F. SuperPolymyxinTM medium for the screening of colistin-resistant Gram-negative bacteria in stool samples. Front Microbiol. 2018;9:2809. https:\/\/doi.org\/10.3389\/fmicb.2018.02809","DOI":"10.3389\/fmicb.2018.02809"},{"key":"ref101","doi-asserted-by":"crossref","unstructured":"Bardet L, Rolain JM. Development of new tools to detect colistin-resistance among Enterobacteriaceae strains. Can J Infect Dis Med Microbiol. 2018;2018:3095249. https:\/\/doi.org\/10.1155\/2018\/3095249","DOI":"10.1155\/2018\/3095249"},{"key":"ref102","doi-asserted-by":"crossref","unstructured":"Naing SY. Screening protocol for colistin resistance using CHROMagar\u2122 COL-APSE medium v1. protocols.io [homepage on the Internet]. Utrecht, Netherlands: Springer Nature; 2025 [cited 2025 Nov 15]. Available from: https:\/\/dx.doi.org\/10.17504\/protocols.io.j8nlky4o1g5r\/v1","DOI":"10.17504\/protocols.io.j8nlky4o1g5r\/v1"},{"key":"ref103","doi-asserted-by":"crossref","unstructured":"Dafopoulou K, Zarkotou O, Dimitroulia E, et al. Comparative evaluation of colistin susceptibility testing methods among carbapenem-nonsusceptible Klebsiella pneumoniae and Acinetobacter baumannii clinical isolates. Antimicrob Agents Chemother. 2015;59(8):4625\u20134630. https:\/\/doi.org\/10.1128\/AAC.00868-15","DOI":"10.1128\/AAC.00868-15"},{"key":"ref104","doi-asserted-by":"crossref","unstructured":"Gautam PK, Tomar S. Detection of colistin resistance via four methods among Gram-negative bacteria. One Health Bull. 2023;3(1):18. https:\/\/doi.org\/10.4103\/2773-0344.385536","DOI":"10.4103\/2773-0344.385536"},{"key":"ref105","doi-asserted-by":"crossref","unstructured":"Anantharajah A, Glupczynski Y, Hoebeke M, et al. Multicenter study of automated systems for colistin susceptibility testing. Eur J Clin Microbiol Infect Dis. 2021;40(3):575\u2013579. https:\/\/doi.org\/10.1007\/s10096-020-04059-4","DOI":"10.1007\/s10096-020-04059-4"},{"key":"ref106","doi-asserted-by":"crossref","unstructured":"Volland H, Dortet L, Bernabeu S, et al. Development and multicentric validation of a lateral flow immunoassay for rapid detection of MCR-1-producing Enterobacteriaceae. J Clin Microbiol. 2019;57(5):e01454\u2013e01518. https:\/\/doi.org\/10.1128\/JCM.01454-18","DOI":"10.1128\/JCM.01454-18"},{"key":"ref107","doi-asserted-by":"crossref","unstructured":"Anjum MF, Zankari E, Hasman H. Molecular methods for detection of antimicrobial resistance. Microbiol Spectr. 2017;5(6). https:\/\/doi.org\/10.1128\/microbiolspec.ARBA-0011-2017","DOI":"10.1128\/microbiolspec.ARBA-0011-2017"},{"key":"ref108","doi-asserted-by":"crossref","unstructured":"Fan Z, Feng Y, Xu W, et al. Rapid detection of multi-resistance strains carrying mcr-1 gene using recombinase-aided amplification directly on clinical samples. Front Microbiol. 2022;13:852488. https:\/\/doi.org\/10.3389\/fmicb.2022.852488","DOI":"10.3389\/fmicb.2022.852488"},{"key":"ref109","doi-asserted-by":"crossref","unstructured":"Hu S, Lv Z, Wang Y, Shen J, Ke Y. Novel quadruplex PCR for detecting and genotyping mobile colistin resistance genes in human samples. Diagn Microbiol Infect Dis. 2021;101(4):115419. https:\/\/doi.org\/10.1016\/j.diagmicrobio.2021.115419","DOI":"10.1016\/j.diagmicrobio.2021.115419"},{"key":"ref110","doi-asserted-by":"crossref","unstructured":"Borowiak M, Baumann B, Fischer J, et al. Development of a novel mcr-6 to mcr-9 multiplex PCR and assessment of mcr-1 to mcr-9 occurrence in colistin-resistant Salmonella enterica isolates from environment, feed, animals and food (2011\u20132018) in Germany. Front Microbiol. 2020;11:80. https:\/\/doi.org\/10.3389\/fmicb.2020.00080","DOI":"10.3389\/fmicb.2020.00080"},{"key":"ref111","doi-asserted-by":"crossref","unstructured":"Al-Mir H, Osman M, Drapeau A, Hamze M, Madec JY, Haenni M. WGS analysis of clonal and plasmidic epidemiology of colistin-resistance mediated by mcr genes in the poultry sector in Lebanon. Front Microbiol. 2021;12:624194. https:\/\/doi.org\/10.3389\/fmicb.2021.624194","DOI":"10.3389\/fmicb.2021.624194"},{"key":"ref112","doi-asserted-by":"crossref","unstructured":"Zwe YH, Chin SF, Kohli GS, Aung KT, Yang L, Yuk HG. Whole genome sequencing (WGS) fails to detect antimicrobial resistance (AMR) from heteroresistant subpopulation of Salmonella enterica. Food Microbiol. 2020;91:103530. https:\/\/doi.org\/10.1016\/j.fm.2020.103530","DOI":"10.1016\/j.fm.2020.103530"},{"key":"ref113","doi-asserted-by":"crossref","unstructured":"Peng K, Li C, Wang Q, Xin X, Wang Z, Li R. The applications and advantages of nanopore sequencing in bacterial antimicrobial resistance surveillance and research. NPJ Antimicrob Resist. 2025;3(1):87. https:\/\/doi.org\/10.1038\/s44259-025-00157-5","DOI":"10.1038\/s44259-025-00157-5"},{"key":"ref114","doi-asserted-by":"crossref","unstructured":"Ma X, Li Y, Liang Y, et al. Development of a DNA microarray assay for rapid detection of fifteen bacterial pathogens in pneumonia. BMC Microbiol. 2020;20(1):177. https:\/\/doi.org\/10.1186\/s12866-020-01842-3","DOI":"10.1186\/s12866-020-01842-3"},{"key":"ref115","doi-asserted-by":"crossref","unstructured":"Gong L, Jin Z, Liu E, et al. Highly sensitive and specific detection of mobilized colistin resistance gene mcr-1 by CRISPR-based platform. Microbiol Spectr. 2022;10(5):e0188422. https:\/\/doi.org\/10.1128\/spectrum.01884-22","DOI":"10.1128\/spectrum.01884-22"},{"key":"ref116","doi-asserted-by":"crossref","unstructured":"Lescat M, Poirel L, Tinguely C, Nordmann P. A resazurin reduction-based assay for rapid detection of polymyxin resistance in Acinetobacter baumannii and Pseudomonas aeruginosa. J Clin Microbiol. 2019;57(3):e01563\u2013e01618. https:\/\/doi.org\/10.1128\/JCM.01563-18","DOI":"10.1128\/JCM.01563-18"},{"key":"ref117","doi-asserted-by":"crossref","unstructured":"Leshaba TMS, Mbelle NM, Sekyere JO. Current and emerging polymyxin resistance diagnostics: A systematic review of established and novel detection methods. bioRxiv. 2020. https:\/\/doi.org\/10.1101\/2020.08.23.20180133","DOI":"10.1111\/jam.15184"},{"key":"ref118","doi-asserted-by":"crossref","unstructured":"Yainoy S, Hiranphan M, Phuadraksa T, Eiamphungporn W, Tiengrim S, Thamlikitkul V. Evaluation of the rapid polymyxin NP test for detection of colistin susceptibility in Enterobacteriaceae isolated from Thai patients. Diag Microbiol Infect Dis. 2018;92(2):102\u2013106. https:\/\/doi.org\/10.1016\/j.diagmicrobio.2018.05.009","DOI":"10.1016\/j.diagmicrobio.2018.05.009"},{"key":"ref119","doi-asserted-by":"crossref","unstructured":"Chabou S, Leangapichart T, Okdah L, Page SL, Hadjadj L, Rolain J-M. Real-time quantitative PCR assay with Taqman \u00ae probe for rapid detection of MCR-1 plasmid-mediated colistin resistance. New Microb New Infec. 2016;13:71\u201374. https:\/\/doi.org\/10.1016\/j.nmni.2016.06.017","DOI":"10.1016\/j.nmni.2016.06.017"},{"key":"ref120","doi-asserted-by":"crossref","unstructured":"Tolosi R, Apostolakos I, Laconi A, et al. Rapid detection and quantification of plasmid-mediated colistin resistance genes (mcr-1 to mcr-5) by real-time PCR in bacterial and environmental samples. J Appl Microbiol. 2020;129(6):1523\u20131529. https:\/\/doi.org\/10.1111\/jam.14738","DOI":"10.1111\/jam.14738"},{"key":"ref121","doi-asserted-by":"crossref","unstructured":"Stubberfield E, AbuOun M, Sayers E, O\u2019Connor HM, Card RM, Anjum MF. Use of whole genome sequencing of commensal Escherichia coli in pigs for antimicrobial resistance surveillance, United Kingdom, 2018. Euro Surveill. 2019;24(50):pii=1900136. https:\/\/doi.org\/10.2807\/1560-7917.ES.2019.24.50.1900136","DOI":"10.2807\/1560-7917.ES.2019.24.50.1900136"},{"key":"ref122","doi-asserted-by":"crossref","unstructured":"Bhatia M, Shamanna V, Nagaraj G, et al. Assessment of in vitro colistin susceptibility of carbapenem-resistant clinical Gram-negative bacterial isolates using four commercially available systems & Whole-genome sequencing: A diagnostic accuracy study. Diagn Microbiol Infect Dis. 2023;108(3):116155. https:\/\/doi.org\/10.1016\/j.diagmicrobio.2023.116155","DOI":"10.1016\/j.diagmicrobio.2023.116155"},{"key":"ref123","unstructured":"World Health Organization. Global Antimicrobial Resistance Surveillance System (GLASS): the detection and reporting of colistin resistance [homepage on the Internet]. Geneva: World Health Organization; 2018 [cited 2025 Nov 15]. Available from: https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/814eeaa0-344f-4b1d-9334-e7d031f40003\/content"},{"key":"ref124","doi-asserted-by":"crossref","unstructured":"Iskandar K, Molinier L, Hallit S, et al. Surveillance of antimicrobial resistance in low- and middle-income countries: A scattered picture. Antimicrob Resist Infect Control. 2021;10(1):63. https:\/\/doi.org\/10.1186\/s13756-021-00931-w","DOI":"10.1186\/s13756-021-00931-w"},{"key":"ref125","doi-asserted-by":"crossref","unstructured":"McCubbin KD, Anholt RM, De Jong E, et al. Knowledge gaps in the understanding of antimicrobial resistance in Canada. Front Public Health. 2021;9:726484. https:\/\/doi.org\/10.3389\/fpubh.2021.726484","DOI":"10.3389\/fpubh.2021.726484"},{"key":"ref126","doi-asserted-by":"crossref","unstructured":"Wang Y, Xu C, Zhang R, et al. Changes in colistin resistance and mcr-1 abundance in Escherichia coli of animal and human origins following the ban of colistin-positive additives in China: An epidemiological comparative study. Lancet Infect Dis. 2020;20(10):1161\u20131171. https:\/\/doi.org\/10.1016\/S1473-3099(20)30149-3","DOI":"10.1016\/S1473-3099(20)30149-3"},{"key":"ref127","doi-asserted-by":"crossref","unstructured":"Rhouma M, Madec JY, Laxminarayan R. Colistin: From the shadows to a One Health approach for addressing antimicrobial resistance. Int J Antimicrob Agents. 2023;61(2):106713. https:\/\/doi.org\/10.1016\/j.ijantimicag.2023.106713","DOI":"10.1016\/j.ijantimicag.2023.106713"},{"key":"ref128","doi-asserted-by":"crossref","unstructured":"Musa K, Okoliegbe I, Abdalaziz T, Aboushady AT, Stelling J, Gould IM. Laboratory surveillance, quality management, and its role in addressing antimicrobial resistance in Africa: A narrative review. Antibiotics. 2023;12(8):1313. https:\/\/doi.org\/10.3390\/antibiotics12081313","DOI":"10.3390\/antibiotics12081313"},{"key":"ref129","doi-asserted-by":"crossref","unstructured":"Kariuki S, Keddy KH, Antonio M, Okeke IN. Antimicrobial resistance surveillance in Africa: Successes, gaps and a roadmap for the future. Afr J Lab Med. 2018;7(2):924. https:\/\/doi.org\/10.4102\/ajlm.v7i2.924","DOI":"10.4102\/ajlm.v7i2.924"},{"key":"ref130","doi-asserted-by":"crossref","unstructured":"Okolie OJ, Igwe U, Ismail SU, Ighodalo UL, Adukwu EC. Systematic review of surveillance systems for AMR in Africa. J Antimicrob Chemother. 2022;78(1):31\u201351. https:\/\/doi.org\/10.1093\/jac\/dkac342","DOI":"10.1093\/jac\/dkac342"},{"key":"ref131","doi-asserted-by":"crossref","unstructured":"Anyanwu MU, Jaja IF, Okpala COR, Njoga EO, Okafor NA, Oguttu JW. Mobile colistin resistance (mcr) gene-containing organisms in poultry sector in low- and middle-income countries: Epidemiology, characteristics, and one health control strategies. Antibiotics. 2023;12(7):1117. https:\/\/doi.org\/10.3390\/antibiotics12071117","DOI":"10.3390\/antibiotics12071117"},{"key":"ref132","doi-asserted-by":"crossref","unstructured":"Anyanwu MU, Marrollo R, Paolucci M, et al. Isolation and characterisation of colistin-resistant Enterobacterales from chickens in Southeast Nigeria. J Glob Antimicrob Resist. 2021;26:93\u2013100. https:\/\/doi.org\/10.1016\/j.jgar.2021.04.030","DOI":"10.1016\/j.jgar.2021.04.030"}],"container-title":["African Journal of Laboratory Medicine"],"original-title":[],"link":[{"URL":"https:\/\/ajlmonline.org\/index.php\/ajlm\/article\/view\/3122\/3489","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T13:23:51Z","timestamp":1780665831000},"score":1,"resource":{"primary":{"URL":"https:\/\/ajlmonline.org\/index.php\/ajlm\/article\/view\/3122"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":133,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.4102\/ajlm.v15i1.3122","relation":{},"ISSN":["2225-2002","2225-2010"],"issn-type":[{"value":"2225-2002","type":"print"},{"value":"2225-2010","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]},"article-number":"a3122"}}