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Emergence and mechanisms of bacterial resistance in surgical infections
1Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
Abstract:
Antimicrobial resistance is commonplace among bacteria involved in surgical infections, including Staphylococcus aureus, enterococci, Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, and Bacteroides species. Resistance traits can be encoded on chromosomes or transmissible plasmids. The basic mechanisms of resistance are alteration of drug target, prevention of drug access to target, and drug inactivation. Examples include alteration of penicillin-binding proteins in resistance to penicillinase-resistant penicillins, ribosomal binding site protection in tetracycline resistance, and beta-lactamase destruction of beta-lactam compounds. Resistance due to the many types of beta-lactamases that have thus far been identified is wide-spread among common pathogens; use of beta-lactam/beta-lactamase inhibitor combinations has proved effective as one means of counteracting such resistance. Contending with resistance involves appropriate use of available antimicrobials, development of novel agents or modification of existing agents, and measures to forestall emergence and spread of resistant organisms.
Insights
Antimicrobial resistance is common in bacteria causing surgical infections. Understanding resistance mechanisms and implementing strategies like using beta-lactam/beta-lactamase inhibitors are crucial for effective treatment.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Antimicrobial resistance (AMR) is a significant challenge in treating bacterial infections, particularly those associated with surgical procedures.
- Common pathogens like Staphylococcus aureus, enterococci, and Escherichia coli exhibit widespread resistance.
- Resistance mechanisms include alterations in drug targets, reduced drug accessibility, and enzymatic drug inactivation.
Purpose of the Study:
- To review the prevalence and mechanisms of antimicrobial resistance in bacteria implicated in surgical infections.
- To discuss strategies for combating antimicrobial resistance in clinical settings.
Main Methods:
- Literature review of studies on antimicrobial resistance in surgical pathogens.
- Analysis of resistance mechanisms, including chromosomal and plasmid-mediated traits.
- Evaluation of therapeutic approaches, such as beta-lactam/beta-lactamase inhibitor combinations.
Main Results:
- Widespread resistance is observed in key surgical pathogens.
- Beta-lactamase-mediated resistance is a prevalent issue, with numerous beta-lactamase types identified.
- Beta-lactam/beta-lactamase inhibitor combinations demonstrate efficacy against resistant strains.
Conclusions:
- Combating antimicrobial resistance requires a multifaceted approach.
- Strategies include judicious antimicrobial use, development of new agents, and infection control measures to prevent resistance spread.