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Efficacy of combinations of colistin with other antimicrobials involves membrane fluidity and efflux machinery

Authors Armengol E, Domenech O, Fusté E, Pérez-Guillén I, Borrell JH, Sierra JM, Vinas M

Received 6 March 2019

Accepted for publication 17 June 2019

Published 11 July 2019 Volume 2019:12 Pages 2031—2038

DOI https://doi.org/10.2147/IDR.S207844

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Cristina Weinberg

Peer reviewer comments 4

Editor who approved publication: Professor Suresh Antony


E Armengol,1 O Domenech,2 E Fusté1,3 I Pérez-Guillén,1 JH Borrell,2 JM Sierra,1 M Vinas1

1Laboratory of Molecular Microbiology and Antimicrobials, Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, Barcelona, Spain; 2Department of Pharmacy, Pharmaceutical Technology and Physical-Chemistry, University of Barcelona, Barcelona, Spain; 3Department of Public Health, Mental Health and Perinatal Nursing. School of Nursing, University of Barcelona, Barcelona, Spain

Objective: Despite its use was abandoned several decades ago, the polycationic peptide colistin has become the last hope to treat severe infections caused by multidrug-resistant Gram-negative bacteria. Thus, the development of colistin resistance may seriously compromise the efficacy of treatment. Moreover, colistin has high toxicity being dose dependent. A potentially effective strategy to avoid resistance may be to combine colistin with other antimicrobials. This may help in the rescue of old antimicrobials and in reducing toxic undesired effects.
Methods: Antimicrobial susceptibility determination, efflux machinery function measurements in different conditions and measurement of inhibition of the extrusion by colistin were performed. Moreover, modifications of anisotropy of the membranes by using fluorescent dyes was accomplished.
Results: Sub-inhibitory concentrations of colistin have a synergistic effect with several antimicrobials that act intracellularly (targeting protein synthesis and DNA replication). This effect was demonstrated through the uptake increases of acridine orange. in Pseudomonas aeruginosa, Escherichia coli and Acinetobacter baumanii but also in an intrinsically colistin-resistant species as Serratia marcescens. Measurements of the anisotropy of bacterial membranes, as a measure of membrane fluidity, showed significant changes indicative of colistin activity.
Conclusion: The alterations in the cellular efflux machinery that resulted in higher intracellular concentrations of acridine orange, and likely of other antimicrobials combined with data of membrane fluidity and measured synergism in vitro allow us to envisage the use of these combinations to fight infections caused by multidrug–resistant bacteria.

Keywords: synergism, cationic antimicrobial peptides, efflux pumps, membrane fluidity

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