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Published on: May 4, 2018
Resistance mechanisms in Pseudomonas aeruginosa and other nonfermentative gram-negative bacteria
1Department of Microbiology and Immunology, University of British Columbia, Vancouver, Canada.
Abstract:
Nonfermentative gram-negative bacilli are still a major concern in compromised individuals. By far the most important of these organisms is Pseudomonas aeruginosa, although Acinetobacter baumannii (previously Acinetobacter calcoaceticus), Stenotrophomonas maltophilia (previously Pseudomonas and Xanthomonas maltophilia), and Burkholderia cepacia (previously Pseudomonas cepacia) are also of substantative concern because of their similar high intrinsic resistances to antibiotics. The basis for the high intrinsic resistance of these organisms is the lower outer-membrane permeability of these species, coupled with secondary resistance mechanisms such as an inducible cephalosporinase or antibiotic efflux pumps, which take advantage of low outer-membrane permeability. Even a small change in antibiotic susceptibility of these organisms can result in an increase in the MIC of a drug to a level that is greater than the clinically achievable level. In this review, the major mechanisms of resistance observed in the laboratory and clinic are summarized.
Insights
Nonfermentative gram-negative bacilli, including Pseudomonas aeruginosa, exhibit high antibiotic resistance due to reduced outer-membrane permeability and efflux pumps. Understanding these resistance mechanisms is crucial for treating infections in vulnerable patients.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Nonfermentative gram-negative bacilli (NFGNB) pose significant challenges in healthcare settings, particularly for immunocompromised individuals.
- Key NFGNB include Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia, and Burkholderia cepacia, all known for intrinsic antibiotic resistance.
Purpose of the Study:
- To review the primary mechanisms of antibiotic resistance in NFGNB.
- To highlight the clinical and laboratory relevance of these resistance strategies.
Main Methods:
- Literature review of major resistance mechanisms in NFGNB.
- Summary of intrinsic and acquired resistance factors.
Main Results:
- NFGNB possess inherent resistance due to low outer-membrane permeability.
- Secondary resistance mechanisms, such as inducible cephalosporinases and antibiotic efflux pumps, are critical.
- Minor changes in susceptibility can lead to drug ineffectiveness.
Conclusions:
- The combination of reduced permeability and active efflux contributes to high-level antibiotic resistance in NFGNB.
- Effective treatment strategies require a thorough understanding of these complex resistance mechanisms.
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