Table 3.
Major Antibiotic Resistance Mechanisms, Detection Methods and Medical Recommendations for Popular Antimicrobial Resistance Genes of Antimicrobial Resistant Bacteria
| Popular Antimicrobial Resistance Genes | Major Antibiotic Resistance Mechanisms | Detection Methods | Medication Recommendation | |
|---|---|---|---|---|
| Methicillin-resistant Staphylococcus aureus77 | mecA | Drug target alteration | MIC determination, disk diffusion tests or latex agglutination to detect PBP2a, genotypically using PCR | Vancomycin, linezolid, teicoplanin, daptomycin, sulfamethoxazole/ trimethoprim (SMZ/TMP) |
| mecB | ||||
| mecC | ||||
| mecD | ||||
| Vancomycin-resistant Enterococcus18 | vanA | Drug target alteration | MIC determination, disk diffusion, the breakpoint agar method, PCR-based methods, DNA microarray-based | Linezolid, nitrofurantoin, fosfomycin (urinary tract infection) |
| vanB | ||||
| vanC | ||||
| vanD/E/F/G/L/M/N | ||||
| Penicillin-resistant Streptococcus pneumoniae20 | pbp1a, pbp2x, pbp2b | Drug target alteration | MIC or disk diffusion, PCR-based methods, DNA microarray-based | Levofloxacin, moxifloxacin, vancomycin |
| ESBL-producing Enterobacteriaceae23,25–28 | blaCTX-M, blaTEM, blaSHV, blaOXA‐10, blaOXA‐13 to 19 | Enzymatic drug inactivation | ESBL gradient test, Combination disk diffusion test (CDT), Broth microdilution, Double disk synergy test (DDST), PCR-based methods, DNA microarray-based | Piperacillin/tazobactam, cefoperazone/sulbactam, oxycephalosporin, cefmetazole, cefminox, cefoxitin, ertapenem |
| Acquired AmpC β-lactamase-producing Enterobacteriaceae24,26,29,30 | blaCMY, blaFOX, blaMOX, blaLAT, blaACC, blaACT, blaMIR‐1, blaDHA | Enzymatic drug inactivation | inhibition of AmpC (cloxacillin or boronic acid derivatives), the Mast ‘AmpC Detection Disc Set’, the AmpC gradient test, PCR-based methods, DNA microarray-based | Ertapenem, imipenem/cilastatin, meropenem, panipenem/betamipron, cefepime |
| Carbapenemase-producing Enterobacteriaceae32,33,78 | blaKPC, blaNDM, blaOXA, blaIMP, blaVIM | Enzymatic drug inactivation | Diffusion methods, combination disk, Carba NP test, CIM, Hodge test, DDS, Etest, PCR, DNA microarray | A combination of drugs is recommended. Available drugs include: polymyxin E (colistin), polymyxin B, ceftazidime-avibactam, fosfomycin, tigecycline, minocycline |
| Multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa41,68–76 | blaTEM, bla SHV, blaCTX-M, blaOXA, blaIMP, blaVIM, blaSIM, blaNDM, blaSPM, blaGIM, blaDIM, intI 1, intI 2, adeA, adeB, adeC, adeRS, adeIJK, abeM, abrp, gyrA/B, pmrA/pmrB/ mcr-1 | Enzymatic drug inactivation, efflux pumps, modification of aminoglycosides, permeability defects, and alteration of target sites | MIC determination, disk diffusion, Etest, PCR-based methods | A combination of drugs is recommended. Available drugs are as follow. Acinetobacter baumannii: polymyxin B Pseudomonas aeruginosa: Polymyxin E (colistin), cefoperazone/sulbactam + minocycline |
Abbreviations: MIC, minimum inhibitory concentration; ESBL-producing, Extended-spectrum β-lactamase-producin.