Abstract
Multidrug-resistant bacteria have on overwhelming impact on human health, as they cause over 670,000 infections and 33,000 deaths annually in the European Union alone. Of these, the vast majority of infections and deaths are caused by only a handful of species—multi-drug resistant Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus spp., Acinetobacter spp. and Klebsiella pneumoniae. These pathogens employ a multitude of antibiotic resistance mechanisms, such as the production of antibiotic deactivating enzymes, changes in antibiotic targets, or a reduction of intracellular antibiotic concentration, which render them insusceptible to multiple antibiotics. The purpose of this review is to summarize in a clinical manner the resistance mechanisms of each of these 6 pathogens, as well as the mechanisms of recently developed antibiotics designed to overcome them. Through a basic understanding of the mechanisms of antibiotic resistance, the clinician can better comprehend and predict resistance patterns even to antibiotics not reported on the antibiogram and can subsequently select the most appropriate antibiotic for the pathogen in question.
Highlights
The burden of antimicrobial resistance (AMR) is overwhelming, as it is estimated that over 670,000 infections by AMR pathogens occur annually in the European Union (EU) alone, claiming more than 33,000 lives
The vast majority of deaths are caused by only a handful of species: multi-drug resistant (MDR) Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter spp. and Enterococcus spp
The purpose of this review is to provide an overview of the major mechanisms of resistance utilized by AMR pathogens of great clinical importance, that is S. aureus, Enterococcus spp., E. coli, P. aeruginosa, Acinetobacter spp. and K. pneumoniae
Summary
The burden of antimicrobial resistance (AMR) is overwhelming, as it is estimated that over 670,000 infections by AMR pathogens occur annually in the European Union (EU) alone, claiming more than 33,000 lives. The vast majority of deaths are caused by only a handful of species: multi-drug resistant (MDR) Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter spp. and Enterococcus spp. Resistance mechanisms in these bacteria have evolved rapidly, owing to the presence of selective pressures. Their defense mechanisms against antibiotics involve the production of antibiotic deactivating enzymes, such as the several classes of β-lactamases (Figure 1) or aminoglycoside modifying enzymes, changes in antibiotic targets, and reduction of intracellular antibiotic concentration, either by limiting the entrance of the antibiotic or facilitating its expulsion. The purpose of this review is to provide an overview of the major mechanisms of resistance utilized by AMR pathogens of great clinical importance, that is S. aureus, Enterococcus spp., E. coli, P. aeruginosa, Acinetobacter spp. and K. pneumoniae
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