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      Audacious Hitchhikers: The Role of Travel and the International Food Trade in the Global Dissemination of Mobile Colistin-Resistance ( mcr) Genes

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      1 , 1 , 2 , *
      Antibiotics
      MDPI
      mcr, colistin, antibiotic resistance, antibiotic-stewardship, travel, trade, food, global dissemination

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          Abstract

          Colistin, a last-resort antibiotic, has been used in controlling infections caused by multidrug-resistant Gram-negative bacterial pathogens. However, recent reports showed a global dissemination of mobile colistin-resistance (mcr) genes, genetic elements that encode resistance to colistin, which has raised public health concerns. These mcr genes threaten the effectiveness of colistin and could limit therapy options for complicated infections. Despite global attention, many facets of the molecular epidemiology of mcr remain poorly characterized. Here, we focus on the role of travel and the international food trade in the dissemination of mcr to countries where these genetic elements and/or colistin resistance are relatively limited in prevalence. We present evidence from the literature on the acquisition of mcr during travel, and the carriage of these genes back to travelers’ countries. We also highlight the potential transmission of mcr via imported foods. These observations emphasize the magnitude of efforts that are needed to control the spread of mcr, and further highlight the challenge of antimicrobial resistance and the urgent need for coordinated global action.

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          Most cited references33

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          Pharmacology of polymyxins: new insights into an 'old' class of antibiotics.

          Increasing antibiotic resistance in Gram-negative bacteria, particularly in Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae, presents a global medical challenge. No new antibiotics will be available for these 'superbugs' in the near future due to the dry antibiotic discovery pipeline. Colistin and polymyxin B are increasingly used as the last-line therapeutic options for treatment of infections caused by multidrug-resistant Gram-negative bacteria. This article surveys the significant progress over the last decade in understanding polymyxin chemistry, mechanisms of antibacterial activity and resistance, structure-activity relationships and pharmacokinetics/pharmacodynamics. In the 'Bad Bugs, No Drugs' era, we must pursue structure-activity relationship-based approaches to develop novel polymyxin-like lipopeptides targeting polymyxin-resistant Gram-negative 'superbugs'. Before new antibiotics become available, we must optimize the clinical use of polymyxins through the application of pharmacokinetic/pharmacodynamic principles, thereby minimizing the development of resistance.
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            Plasmid-mediated colistin resistance (mcr-1 gene): three months later, the story unfolds.

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              Detection of mcr-1 encoding plasmid-mediated colistin-resistant Escherichia coli isolates from human bloodstream infection and imported chicken meat, Denmark 2015.

              The plasmid-mediated colistin resistance gene, mcr-1, was detected in an Escherichia coli isolate from a Danish patient with bloodstream infection and in five E. coli isolates from imported chicken meat. One isolate from chicken meat belonged to the epidemic spreading sequence type ST131. In addition to IncI2, an incX4 replicon was found to be linked to mcr-1. This report follows a recent detection of mcr-1 in E. coli from animals, food and humans in China.
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                Author and article information

                Journal
                Antibiotics (Basel)
                Antibiotics (Basel)
                antibiotics
                Antibiotics
                MDPI
                2079-6382
                01 July 2020
                July 2020
                : 9
                : 7
                : 370
                Affiliations
                [1 ]Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Riad El Solh, Beirut 1107 2020, Lebanon; jwh03@ 123456mail.aub.edu
                [2 ]Center for Food Safety and Department of Food Science and Technology, University of Georgia, 1109 Experiment Street, Griffin, GA 30223-1797, USA
                Author notes
                Author information
                https://orcid.org/0000-0002-2978-9573
                Article
                antibiotics-09-00370
                10.3390/antibiotics9070370
                7400688
                32630272
                d411431c-f659-46e9-8c4c-b945de4fb03a
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 02 June 2020
                : 29 June 2020
                Categories
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                mcr,colistin,antibiotic resistance,antibiotic-stewardship,travel,trade,food,global dissemination

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