TABLE 1.
Clinical characteristics of ESKAPE pathogensa
| Species | Resistances | Clinical manifestations | Major ST/CC | Mortality rates | Treatments | Key characteristics |
|---|---|---|---|---|---|---|
| Vancomycin-resistant Enterococcus | Vancomycin (184, 471), ampicillin (472), linezolid (35), teicoplanin (473), piperacillin (474), cephalosporins (64), multidrug resistant (184) | Catheter-associated-UTI, vascular catheter-associated bacteremia, intra-abdominal and pelvic infection, endocarditis (51) | E. faecium ST17 (CC17) (35), ST203 (CC17) (475), ST796 (476), ST1421 (35), and CC17 (36); E. faecalis CC2 (477), CC9 (477), ST6 (478), and ST16 (479) | Over 30% for bacteremia (35, 480); 2.5-fold increase in mortality from bacteremia caused by VRE compared to that from bacteremia caused by vancomycin-sensitive bacteria (473) | Nitrofurantoinb (481), fosfomycin (482), linezolid (480), daptomycin (18), chloramphenicol (483), doxycycline (483), high-dose ampicillin and sulbactam (483), omadacycline (396) | 10% of all HA bloodstream infections (484, 485); tolerant to heat, chlorine, and alcohol preparations (486); E. faecium demonstrates significantly higher levels of resistance than E. faecalis (35); commonly encountered as asymptomatic colonization (487) |
| Methicillin-resistant S. aureus | Aminoglycosides (488), β-lactams (489), chloramphenicol (488), trimethoprim (313), macrolides (313), tetracycline (313), fluoroquinolones (64), multidrug resistant (488) | Acute bacterial skin and skin structure infection (490), bacteremia (488), pneumonia (491), osteoarticular infection (492), endocarditis (488) | ST5 (65), ST8 (493), ST22 (35), ST30 (494), ST59 (495), ST72 (CC8) (496), ST80 (70), ST398 (livestock associated) (71, 497) | Greater than 20% for bloodstream infection (76, 77); overall mortality ranges from 15–50% (498) | Vancomycin (488), clindamycin (499), daptomycin (500), linezolid (501), tedizolid (502), dalbavancin (503), tigecycline (504), trimethoprim and sulfamethoxazole (505), pristinamycin (506), omadacycline (396), lefamulin (403) | In Asia, 50% of all S. aureus bloodstream infections are caused by MRSA (507); in USA, HA-MRSA infections have decreased by 54% (508); in Europe, the total proportion of reported MRSA infections among S. aureus infections decreased from 19.6% in 2014 to 16.4% in 2018 (64); 20–40% of the population carries S. aureus as a commensal organism (488) |
| K. pneumoniae | Polymyxins (276), carbapenems (509), fluoroquinolones (64), third-generation cephalosporins (64), aminoglycosides (64), tetracyclines (276), pandrug resistant (276) | Pneumonia (510), pyogenic liver abscesses (511), necrotizing and soft tissue infection (92), bloodstream infection, meningitis (512), endophthalmitis (512), UTI (513) | ST11 (82, 514), ST15 (82, 515), ST17 (516), ST37 (516), ST101 (82, 517), ST147 (518), ST258 (148, 519), ST307 (88, 89), ST405 (520), ST512 (82) | 40% to 70% for CRKP bloodstream infection (509, 521); 40% for CRKP pulmonary infection (521, 522); 25% to 47% for hvKP necrotizing and soft tissue infection (90, 92) | Aminoglycosides (523), polymyxin combination therapy (524), tigecycline (79), meropenem (523), meropenem-vaborbactam (525), ertapenem and meropenem (526), imipenem-cilastatin-relebactam (24), ceftazidime-avibactam (527), plazomicin (393), eravacycline (394) | USA has more than 7,000 HA-CRKP infections per year (80); in Taiwan, 80% of pyogenic liver abscess cases are attributed to hvKP (511) |
| A. baumannii | Carbapenems (103), polymyxins (108), β-lactams (103), tigecycline (103), ceftazidime (103), fourth-generation cephalosporins (103), multidrug resistant (101, 103) | Ventilator-associated pneumonia (528), central line bloodstream infections (528), nosocomial meningitis (529), skin and soft tissue infection (530), catheter-associated UTI (528) | ST195 (CC92) (531), ST457 (CC92) (531), pan-European epidemic clones I, II, and III (532) | 35% for ventilator-associated pneumonia and bloodstream infections (533) | Colistin (534), tigecycline (102), cefiderocol (412), eravacycline (394) | 2% of all HA-infections in USA and Europe (100, 101); high mutation frequency upon desiccation (535); persistence in biofilms during soft tissue infection (536); tolerance to low-ethanol environments and resistance to chlorhexidine-based disinfectants (537, 538) |
| P. aeruginosa | First- and second-generation cephalosporins (110), piperacillin-tazobactam (35, 110), aminoglycosides (110), quinolones (110), carbapenems (35, 110), polymyxins (110), multidrug resistant (539) | UTI (540), bloodstream infection (539), ventilator-associated pneumonia (64), chronic respiratory infection (541), skin and soft tissue infection (542), endocarditis (543) | ST111 (544), ST175 (112, 544), ST233 (544), ST235 (111, 545), ST253 (544), ST292 (114), ST1725 (544) | 67% for MDR bacteremia (539); 33.9% for UTI (540) | Piperacillin-tazobactam (35), ceftolozane-tazobactam (546), ceftazidime (35), meropenem (35), ciprofloxacin (35), ceftazidime-avibactam (527), cefiderocol (412), imipenem-cilastatin-relebactam (24) | High incidence of infection in burn victims (542); 51,000 HA infections in USA per year (547–550) |
| Enterobacter species | Carbapenems (3), fourth-generation cephalosporins (102), fluoroquinolones (102), β-lactams (157), polymyxins (130), multidrug resistant (102), pandrug resistant (130) | UTI (551), bloodstream infection (552), neonatal pneumonia (553), skin and soft tissue infection (554), intra-abdominal infection (555), endocarditis (556), septic arthritis (556) | In K. aerogenes, ST4 (127) and ST93 (127); in E. cloacae, ST66 (557), ST78 (557), ST108 (557), ST144 (557), and ST171 (128) | Exceeds 40% for E. cloacae bloodstream infection (552, 558) | Nitrofurantoinb (35), cefepime (35), ceftriaxone (35), ciprofloxacin (35), gentamicin (35), meropenem (35), piperacillin-tazobactam (35), trimethoprim with or without sulfamethoxazole (35), imipenem-cilastatin-relebactam (24) | E. cloacae is the 3rd most frequent Enterobacterales species causing bloodstream infection (552); infections are prevalent in neonates and elderly individuals (556, 559); clinically relevant E. hormaechei is an important emerging pathogen within the E. cloacae complex (125, 126) |
a
Abbreviations: ST, sequence type; CC, clonal complex; UTI, urinary tract infection; HA, hospital acquired; CRKP, carbapenem-resistant K. pneumoniae; hvKP, hypervirulent K. pneumoniae.
b
Nitrofurantoin is prescribed only for uncomplicated urinary tract infections.