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Updated: May 30, 2026

Testing the Role of Multicopy Plasmids in the Evolution of Antibiotic Resistance
Published on: May 2, 2018
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
Abstract:
Co-resistance involves transfer of several genes into the same bacteria and/or the acquisition of mutations in different genetic loci affecting different antimicrobials whereas pleiotropic resistance implies the same genetic event affecting several antimicrobials. There is an increasing prevalence of isolates with co-resistance which are over-represented within the so-called high-risk clones. Compensatory events avoid fitness cost of co-resistance, even in the absence of antimicrobials. Nevertheless, they might be selected by different antimicrobials and a single agent might select co-resistant isolates. This process, named as co-selection, is not avoided with cycling or mixing strategies of antimicrobial use. Co-resistance and co-selection processes increase the opportunity for persistence of the bacteria and resistance genes and should be considered when designing strategies for decreasing antimicrobial resistance.
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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