Role of efflux pumps, their inhibitors, and regulators in colistin resistance

Colistin is highly promising against multidrug-resistant and extensively drug-resistant bacteria clinically. Bacteria are resistant to colistin mainly through mcr chromosome-mediated lipopolysaccharide (LPS) synthesis-related locus variation. However, the current understanding cannot fully explain resistance mechanism in -negative colistin-resistant strains. Significantly, contribution of efflux pumps remains be clarified. This review aims discuss their related transcriptional regulators various reversal effect pump inhibitors on resistance. Previous studies suggested a complex regulatory relationship between LPS synthesis, transport, modification. Carbonyl cyanide 3-chlorophenylhydrazone (CCCP), 1-(1-naphthylmethyl)-piperazine (NMP), Phe-Arg-β-naphthylamide (PAβN) all achieved resistance, highlighting role potential for adjuvant development. The might also specific genetic backgrounds. They can participate tolerance heterogeneous affect treatment efficacy colistin. These findings help understand development