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Related Concept Videos

Development of Antibiotic Resistance01:30

Development of Antibiotic Resistance

Antibiotic resistance is a major public health concern that arises when bacteria evolve mechanisms to withstand the effects of antibiotic treatments. This resistance can be intrinsic, acquired through genetic mutations, or transferred between bacteria via horizontal gene transfer. The development of antibiotic resistance poses significant challenges in treating bacterial infections and necessitates ongoing research to develop new therapeutic strategies.Intrinsic resistance occurs when bacterial...
Inhibitors of Gram-positive Cell Wall Synthesis01:23

Inhibitors of Gram-positive Cell Wall Synthesis

Bacterial cell walls are typically rigid structures composed mainly of peptidoglycan, a mesh-like polymer that provides mechanical strength and maintains cell shape. The synthesis of peptidoglycan is a crucial process in bacterial growth and serves as a primary target for many antibiotics.Mechanism of Action of Beta-Lactam AntibioticsBeta-lactam antibiotics, such as penicillin, inhibit peptidoglycan synthesis in actively growing cells. These antibiotics share a characteristic four-membered...
Mechanism of Antibiotic Resistance in MRSA01:25

Mechanism of Antibiotic Resistance in MRSA

Antibiotic resistance in bacteria arises when microorganisms evolve the ability to withstand drugs designed to kill them or inhibit their growth, rendering once-effective treatments useless. This phenomenon, driven by genetic change and selection under antibiotic exposure, poses a profound threat to modern medicine. Mechanisms include drug-inactivating enzymes (e.g., β-lactamases), efflux pumps that eject antibiotics, mutations altering antibiotic targets, decreased drug uptake, and acquisition...
Clinical Significance of Antibiotic Resistance01:25

Clinical Significance of Antibiotic Resistance

Methicillin-resistant Staphylococcus aureus (MRSA) presents a critical public health threat, arising from its capacity to resist β-lactam antibiotics due to acquisition of the mecA gene within the staphylococcal cassette chromosome mec (SCCmec). This gene encodes penicillin-binding protein 2a (PBP2a), which impairs binding efficacy of methicillin and other β-lactams. MRSA has evolved into distinct clonal lineages impacting humans and animals alike, reinforcing its significance within the One...
Acute Pyelonephritis II: Diagnostic Studies and Management01:28

Acute Pyelonephritis II: Diagnostic Studies and Management

Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
Inhibitors of Bacterial DNA Synthesis01:28

Inhibitors of Bacterial DNA Synthesis

Bacterial pathogens depend on precise and efficient DNA replication to sustain infection. Two type II topoisomerases—DNA gyrase and topoisomerase IV—are critical to this process, as they resolve DNA supercoiling and unlink chromosomes during replication. Fluoroquinolones, synthetic derivatives of quinolones, exploit this mechanism by stabilizing the transient DNA–enzyme cleavage complex, preventing strand religation, and causing lethal double-strand breaks. These antibiotics are selectively...

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Updated: May 7, 2026

Generating Transposon Insertion Libraries in Gram-Negative Bacteria for High-Throughput Sequencing
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Generating Transposon Insertion Libraries in Gram-Negative Bacteria for High-Throughput Sequencing

Published on: July 7, 2020

Resistant gram-negative infections.

Henry Fraimow1, Raquel Nahra

  • 1Department of Medicine, Cooper Medical School of Rowan University, 401 Haddon Avenue, Room 278, Camden, NJ 08103, USA.

Critical Care Clinics
|October 8, 2013
PubMed
Summary

The global rise of drug-resistant gram-negative bacilli in intensive care units poses a significant threat. This review covers antimicrobial treatments and strategies to enhance their effectiveness against these challenging infections.

Keywords:
Acinetobacter speciesAntibiotic resistanceEnterobacteriaceaeGram-negative bacilliPseudomonas aeruginosaSeptic shock

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Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Microbiology

Background:

  • Intensive care units (ICUs) face a growing crisis due to multidrug-resistant (MDR) gram-negative bacilli.
  • These pathogens are associated with high morbidity and mortality rates in critically ill patients.
  • The emergence of resistance necessitates novel therapeutic approaches and optimized antimicrobial use.

Purpose of the Study:

  • To review the current global landscape of resistant gram-negative bacilli in ICUs.
  • To discuss available antimicrobial agents for treating infections caused by these resistant organisms.
  • To explore strategies for maximizing the efficacy of antimicrobial therapies in the ICU setting.

Main Methods:

  • Literature review of global studies on resistant gram-negative bacilli in ICUs.
  • Analysis of antimicrobial drug classes effective against resistant gram-negative pathogens.
  • Examination of antimicrobial stewardship and combination therapy strategies.

Main Results:

  • Resistant gram-negative bacilli, including carbapenem-resistant Enterobacteriaceae (CRE) and Acinetobacter baumannii, are prevalent in ICUs worldwide.
  • Treatment options are limited, often relying on last-resort antibiotics with potential toxicities.
  • Optimizing antimicrobial use through stewardship, combination therapy, and pharmacokinetic/pharmacodynamic (PK/PD) adjustments is crucial.

Conclusions:

  • The escalating threat of resistant gram-negative bacilli in ICUs requires urgent global attention.
  • Effective management involves a combination of judicious antimicrobial selection, novel therapeutic strategies, and robust infection control measures.
  • Further research into new antimicrobial agents and treatment paradigms is essential to combat this crisis.