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Background  Colistin resistance is mainly driven by alterations in the Gram-negative outer membrane lipopolysaccharides and is caused, in most cases, by mutations in  mgrB  gene. However, the recent emergence of plasmid-encoded colistin resistance among  Enterobacteriaceae  strains represents a serious threat to global public health. In this paper we have investigated the rates of colistin resistance and the underlying mechanisms in 450  Klebsiella pneumoniae  and  Escherichia coli  isolates obtained from cancer patients in Egypt.    Methods  Colistin susceptibility and minimum inhibitory concentrations were determined according to the European Committee on Antimicrobial Susceptibility Testing, by broth microdilution, and by E-test. The  mcr - 1 ,  mcr - 2  and  mgrB  genes were detected by PCR and then sequenced. Clonal diversity in colistin-resistant  K. pneumoniae  was evaluated by multilocus sequence typing.    Results  Forty (8.8%) colistin-resistant isolates, including 22  K. pneumoniae  and 18  E. coli , were isolated over 18 months. Of these, 50% were carbapenem-resistant, out of which nine were  bla   OXA - 48   and seven  bla   NDM - 1   positive. The mechanisms of colistin resistance could be revealed only in three of the 40 resistant strains, being represented by mcr-1 in one  bla   NDM - 1  -positive  E. coli  strain and in one  K. pneumoniae  ST11 and by  mgrB  mutations, detected in one  K. pneumoniae  isolate. None of the studied isolates harbored  mcr - 2 .    Conclusions  Our results demonstrate a high frequency of colistin resistance in enterobacterial strains isolated from cancer patients, but a low prevalence of the most well known resistance mechanisms.

Emergence of colistin resistance in multidrug-resistant Klebsiella pneumoniae and Escherichia coli strains isolated from cancer patients