Gram-negative ESKAPE pathogens, including A cinetobacter baumannii , are responsible for a dramatic increase in the morbidity and mortality of patients in healthcare settings over the past two decades. Infections are difficult to treat due to antibiotic resistance and tolerance; however, broadly conserved mechanisms that promote antibiotic treatment failure have not been extensively studied. Herein, we identify an alternative lipid biosynthesis pathway that is induced in phosphate starvation that enables Gram-negative ESKAPE pathogens, including A. baumannii , Klebsiella pneumoniae , and Enterobacter cloacae to build lipid bilayers in the absence of glycerophospholipids, which are the canonical bilayers lipid. Replacement of the anionic phosphate in the lipid headgroup with zwitterionic ornithine and lysine promote survival against colistin, a last resort antimicrobial used against Gram-negative infections. These studies suggest that ESKAPE pathogens can remodel their bilayers with phosphate free lipids to overcome colistin treatment and that aminolipid biosynthesis could be targeted to improve antimicrobial treatment.
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