Antimicrobial resistance: revisiting the mechanisms of resistance

Resistance to antibiotics persists as a critical challenge in public health. Currently, the emergence of multi-drug resistant (MDR) bacteria is a primary concern globally, resulting in a dramatic increase in epidemiological relevance and importance of nosocomial and chronic infections. Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacteriaceae has recently been classified as critical in the World Health Organization (WHO) priority pathogens. Among these bacterial pathogens, resistance seems to be a natural trait. The acquisition and development of resistance by bacteria is through several mechanisms. The genetic background and intrinsic resistance mechanisms largely contribute to competitive advantage and resistance in a highly resistant pool. The acquisition of resistance genes driven by mobile genetic elements (MGE) and several biochemical mechanisms also plays a central role in resistance development among pathogenic bacteria. This review discussed the recent underlying multiple resistance mechanisms among the priority pathogens. This review also provides an up-to-date regional epidemiological data and implications of antimicrobial resistance. Given the severity of infections caused by these bacteria, their less susceptibility to the available antimicrobials, and the limited antimicrobial arsenal to treat these pathogens, current insight on resistance mechanisms becomes timely and highly relevant. This information will help develop better therapeutic strategies against resistance microbes, especially those of urgent priority.