Co-resistance: an opportunity for the bacteria and resistance genes

Rafael Cantón1, Patricia Ruiz-Garbajosa

  • 1Servicio de Microbiología and CIBER en Epidemiología y Salud Pública, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Carretera Colmenar Km 9.1. 28034 Madrid, Spain. rcanton.hrc@salud.madrid.org

Insights

Co-resistance, where bacteria gain multiple antimicrobial resistance genes, is increasing, especially in high-risk clones. Compensatory mechanisms and co-selection mean strategies to reduce antimicrobial resistance must account for these combined resistance factors.

Area of Science:

  • Microbiology
  • Genetics
  • Epidemiology

Background:

  • Co-resistance involves multiple genetic events conferring resistance to various antimicrobials.
  • Pleiotropic resistance results from a single genetic event affecting multiple antimicrobials.
  • High-risk bacterial clones increasingly exhibit co-resistance, posing a significant public health challenge.

Purpose of the Study:

  • To differentiate between co-resistance and pleiotropic resistance mechanisms.
  • To investigate the role of compensatory events in bacterial fitness.
  • To understand the implications of co-selection on antimicrobial resistance dynamics.

Main Methods:

  • Comparative analysis of genetic mechanisms underlying co-resistance and pleiotropic resistance.
  • Investigation of bacterial fitness costs associated with co-resistance.
  • Modeling of co-selection processes under different antimicrobial usage strategies.

Main Results:

  • Co-resistance is characterized by multiple genetic loci or gene transfers, distinct from pleiotropic resistance.
  • Compensatory events can mitigate fitness costs of co-resistance, facilitating persistence.
  • Antimicrobial cycling or mixing strategies do not prevent co-selection of resistant isolates.

Conclusions:

  • Co-resistance and co-selection significantly enhance bacterial persistence and the spread of resistance genes.
  • Current antimicrobial usage strategies may inadvertently promote co-resistance.
  • Novel strategies are needed to combat antimicrobial resistance, considering co-resistance and co-selection dynamics.

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