The secret weapon to reduce multidrug-resistant Gram-negative infections: can vaccines help decrease MDR risk?

To describe the current and potential role of vaccination to fight against antimicrobial resistance (AMR), with a special focus on multidrug resistance (MDR) Gram-negative bacteria (GNB).

The increasing threat of AMR and the complexities of developing new antibiotics has stimulated the search for alternative preventive strategies, including vaccines.

Vaccination is an important and underestimated tool for counteracting AMR both in high- and low-income countries. Vaccine use produces various direct and indirect effects that reduce infections caused by MDR bacteria and antibiotic consumption associated with diseases at population level. Vaccines are associated with risk for resistance, yet the probability is extremely low compared to antibiotics. The main strategic goals to prevent and control AMR include not only expanding the use of licensed vaccines, but also developing new vaccines and improving knowledge of related impact on AMR. Current vaccine pipeline for GNB has several options, but needs to overcome diverse challenges. Future research ought to optimize the use of vaccines to fight AMR crisis.