Beyond antibiotics: Multidimensional interventions and coordinated governance against ESKAPE resistance

Area of Science:

• Microbiology
• Public Health
• Infectious Diseases

Background:

• ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp.) present a significant global health challenge.
• Extensive drug resistance and rapid evolution exacerbate the threat posed by these multidrug-resistant organisms.

Purpose of the Study:

• To advocate for a paradigm shift from traditional antibiotic use to "ecological co-management" for controlling ESKAPE pathogens.
• To present an integrated approach combining novel strategies for sustainable pathogen control.

Main Methods:

• Microbiome-based interventions (probiotics, phages, niche modulation).
• One Health 2.0 framework (wastewater surveillance, AI-driven stewardship).
• Evolutionary constraint methods (anti-virulence agents, CRISPR-based targeting).
• Metabolic pathway intervention (antimetabolite therapy, biotin biosynthesis inhibition).
• Clinical translation and risk management system for novel antimicrobial strategies.

Main Results:

• The proposed multidimensional strategies aim to disrupt antimicrobial resistance transmission.
• Restoration of antibiotic susceptibility is a key objective.
• Promotion of sustainable pathogen control through ecological and systems-level integration.

Conclusions:

• Ecological co-management offers a novel framework for addressing the global threat of ESKAPE pathogens.
• Integrating diverse strategies is crucial for combating antimicrobial resistance and ensuring long-term infectious disease management.