Table 3.
Summary of the alternate strategies employed against the ESKAPE organisms and their limitations.
| Alternate strategy | Function | Resistant organism(s) | Other limiting factor(s) | Reference(s) |
|---|---|---|---|---|
| β-Lactamase inhibitors | Prevent degradation of the β-lactam antibiotics | • Enterococcus sp. • Klebsiella pneumoniae |
– | (Drawz and Bonomo, 2010; Ripoll et al., 2014) |
| Efflux pump inhibitors | Inhibit the efflux pumps, thereby localizing the antibiotics within the bacterial cell | – | • Difficulty in synthesizing the compounds • Solubility • Toxicity • Constraints in cell permeability • Drug compatibility |
(Sharma et al., 2019) |
| Phage therapy | Employs bacteriophages to kill the pathogen | • Enterococcus sp. • K. pneumoniae • Pseudomonas aeruginosa |
• Difficulty in tailoring the phage genome • Risk of inducing AMR • Hindrance of the immune response |
(Oechslin, 2018; Principi et al., 2019) |
| Monoclonal antibodies | Bind to the specific epitope of the bacterial cell and instigate an immunological response | – | • Mode of action • Precise control of the characteristics like molecular size, shape, affinity, and valency |
(Chames et al., 2009) |
| Vaccination | Prevents the corresponding bacterial infection | – | • Reversal of virulence, if live bacteria is employed as the vaccinating agent • Constantly mutating target*// |
(Bacterial Vaccine - an overview | ScienceDirect Topics) |
| Fecal microbiota transplant | Aids in reversing dysbiosis by maintaining a healthy microbiome | – | • Difficulty in finding an ideal donor • Harmful microbial transfer to the donors • Colonization resistance |
(Leshem et al., 2019) |
| Plasmid curing | Inhibits the conjugational transfer of the antibiotic-resistant plasmid | – | – | – |
| Conjugation inhibitors | Prevents horizontal gene transfer by inhibiting bacterial conjugation | – | – | – |
| Nanoparticles | • Target multiple mechanisms such as cell wall formation, biofilm formation, RNA, and protein synthesis. • Increase the production of reactive oxygen species (ROS) and disintegrates the membrane potential of the bacterial cell. • Trigger the host immune response systems |
– | • Difficulty in ensuring surface stability and surface accessibility • Problems associated with optimizing the concentration |
(Duval et al., 2019; Lee et al., 2019) |
| Antimicrobial peptides | Disrupt the membrane potential and alter the permeability of the bacterial cell wall | – | • Toxicity and stability | |
| Antimicrobial light therapy | Employs low-power lasers and photosensitive drugs to target the pathogens | – | – | – |
| Immune boosters | Stimulate the host immune system | – | – | – |
“-” denotes insufficient information.