title: Resistance mechanisms.
abstract: By definition, the terms sepsis and septic shock refer to a potentially fatal infectious state in which the early administration of an effective antibiotic is the most significant determinant of the outcome. Because of the global spread of resistant bacteria, the efficacy of antibiotics has been severely compromised.S. pneumonia,Escherichia coli(E. coli),Klebsiella,Acinetobacter, andPseudomonasare the predominant pathogens of sepsis and septic shock. It is common forE. coli,Klebsiella,AcinetobacterandPseudomonasto be resistant to multiple drugs. Multiple drug resistance is caused by the interplay of multiple resistance mechanisms those emerge via the acquisition of extraneous resistance determinants or spontaneous mutations. Extended-spectrum beta-lactamases (ESBLs), carbapenemases, aminoglycoside-modifying enzymes (AMEs) and quinolone resistance determinants are typically external and disseminate on mobile genetic elements, while porin-efflux mechanisms are activated by spontaneous modifications of inherited structures. Porin and efflux mechanisms are frequent companions of multiple drug resistance inAcinetobacterandP. aeruginosa,but only occasionally detected amongE. coliandKlebsiella. Antibiotic resistance became a global health threat. This review examines the major resistance mechanisms of the leading microorganisms of sepsis.
authors.affiliation: Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Department, Istanbul Medeniyet Universitesi Goztepe Egitim Arastirma Hastanesi, Istanbul, Turkey.
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Cag
authors.affiliation: Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Department, Istanbul Medeniyet Universitesi Goztepe Egitim Arastirma Hastanesi, Istanbul, Turkey.
authors.forename: Hulya
authors.initials: H
authors.lastname: Caskurlu
authors.affiliation: Lab of Clinical Microbiology and Infectious Diseases, China-Japan Friendship Hospital, Beijing 100029, China.
authors.forename: Yanyan
authors.initials: Y
authors.lastname: Fan
authors.affiliation: Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Cao
authors.affiliation: Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Department, Istanbul Medeniyet Universitesi Goztepe Egitim Arastirma Hastanesi, Istanbul, Turkey.
authors.forename: Haluk
authors.initials: H
authors.lastname: Vahaboglu
keywords: Acinetobacter; Escherichia coli (E. coli); Klebsiella; Pseudomonas; beta-lactamases; carbapenemase; drug resistance, multiple; septic; shock