title: Antibiotic resistance in Enterobacteriaceae: mechanisms and clinical implications.
abstract: Resistance of the Enterobacteriaceae to antibiotics, especially of the β lactam type, is increasingly dominated by the mobilization of continuously expressed single genes that encode efficient drug modifying enzymes. Strong and ubiquitous selection pressure has seemingly been accompanied by a shift from "natural" resistance, such as inducible chromosomal enzymes, membrane impermeability, and drug efflux, to the modern paradigm of mobile gene pools that largely determine the epidemiology of modern antibiotic resistance. In this way, antibiotic resistance is more available than ever before to organisms such as Escherichia coli and Klebsiella pneumoniae that are important causes of major sepsis. Modulation of the phenotype by host bacteria makes gene transmission less obvious and may in part explain why tracking and control of carbapenem resistance has been particularly problematic in the Enterobacteriaceae. This review discusses the underlying principles and clinical implications of the mobility and fixation of resistance genes and the exploitable opportunities and potential threats arising from apparent limitations on diversity in these mobile gene pools. It also provides some illustrative paradoxes and clinical corollaries, as well as a summary of future options.
authors: Westmead Institute for Medical Research, University of Sydney and Marie Bashir Institute, Sydney, NSW, Australia jonathan.iredell@sydney.edu.au.
authors: Jon
authors: J
authors: Iredell
authors: Department of Microbiology, Institute of Clinical Pathology and Medical Research, Sydney.
authors: Jeremy
authors: J
authors: Brown
authors: Westmead Institute for Medical Research, University of Sydney and Marie Bashir Institute, Sydney, NSW, Australia.
authors: Kaitlin
authors: K
authors: Tagg
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics; D024881:Drug Resistance, Bacterial / Q000235:genetics / Q000502:physiology*; D004755:Enterobacteriaceae / Q000187:drug effects / Q000235:genetics / Q000502:physiology*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology; D014644:Genetic Variation; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins