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Acinetobacter baumannii  is a significant cause of opportunistic hospital acquired infection and has been identified as an important emerging infection due to its high levels of antimicrobial resistance. Multidrug resistant  A. baumannii  has risen rapidly in Vietnam, where colistin is becoming the drug of last resort for many infections. In this study we generated spontaneous colistin resistant progeny (up to >256 μg/μl) from four colistin susceptible Vietnamese isolates and one susceptible reference strain (MIC <1.5 μg/μl). Whole genome sequencing was used to identify single nucleotide mutations that could be attributed to the reduced colistin susceptibility. We identified six  lpxACD  and three  pmrB  mutations, the majority of which were novel. In addition, we identified further mutations in six  A. baumannii  genes ( vacJ ,  pldA ,  ttg2C ,  pheS  and conserved hypothetical protein) that we hypothesise have a role in reduced colistin susceptibility. This study has identified additional mutations that may be associated with colistin resistance through novel resistance mechanisms. Our work further demonstrates how rapidly  A. baumannii  can generate resistance to a last resort antimicrobial and highlights the need for improved surveillance to identified  A. baumannii  with an extensive drug resistance profile.

The induction and identification of novel Colistin resistance mutations in Acinetobacter baumannii and their implications