Fig 4. Schematic diagram for melioidosis diagnosis and list of sensitive and resistance antibiotics.

There are several factors, such as inactivation of enzyme, target deletion, and drug efflux pumps from the cells mediated by chromosomally encoded genes. Furthermore, the overproduction and point mutations in class A PenA β-lactamase affect some of the important drugs (i.e., ceftazidime and amoxicillin-clavulanic acid) that are responsible for the development of resistance mechanisms. However, the deletion of penicillin binding protein-3 (PBP-3) leads to ceftazidime resistance, and BpeEF-OprC efflux pump overexpression causes doxycycline, trimethoprim, and trimethoprim (TMP)-sulfamethoxazole (SFZ) resistance.