Table 1.
Family | Mode of action | Mechanism of resistance | Resistant gene | Locationa | Reference |
---|---|---|---|---|---|
β-lactams | Cell wall synthesis inhibitors. Binds transpeptidase also known as penicillin binding proteins (PBPs) that help form peptidoglycan | Beta-lactamase production primarily-bla genes | mecC (mecALGA251) mecA blaZ | C C |
(83, 86, 87) |
Inactivates the enzyme; beta-lactamase | Expression of alternative PBPs | Tn, P, C | |||
β-lactamase inhibitors | Hydrolysis of the beta-lactam ring | Production of extended spectrum beta-lactamases (ESBLs) |
blaSHV blaTEM |
P, C P, C |
|
Fluoroquinolones | Binds DNA-gyrase or topoisomerase II and topoisomerase IV; enzymes needed for supercoiling, replication and separation of circular bacterial DNA. | Target modification Decreased membrane permeability Efflux pumps |
qnrA qnrB qnrS 9, 10 |
P P P |
(85, 88) |
Macrolides, Licosamides and Streptogamin (MLS) | Binds the bacterial 50 S ribosomal subunits; inhibit protein synthesis | Target site modification |
ermA, (ermB), ermC, ermF, ermT, erm (73) erm (83) |
C, Tn, P, (Tn,P) P, C P, P C |
(89, 90) |
Active drug efflux | msr (A) except lincosamides | C, P | |||
Aminoglycosides | Bind to the bacterial 30 S ribosomal subunit thus inhibit bacterial protein synthesis | Target site modification [via the action of 16 S rRNA methyltransferases (RMTs)] | (89, 91, 92) | ||
Enzymatic drug modification (adenylation, acetylation and phosphorylation) | aacA-aphD aadD |
Tn, P, C P, C |
|||
Efflux systems |
aadE str |
Tn, P P |
|||
Tetracyclines | Bind reversibly to the 30 S ribosomal subunit as such blocks the binding of the aminoacyl-tRNA to the acceptor site on the mRNA-ribosome complex | Efflux systems Target modification Inactivating enzymes Ribosomal protection |
Tet (K), tet (K) Tet (M), tet (O) | P Tn/C, C |
(93, 94) |
Sulfonamides (Folate pathway inhibitors) | Inhibit the bacterial enzyme dihydropteroate synthetase (DPS) in the folic acid pathway, thereby blocking bacterial nucleic acid synthesis | Excessive bacterial production of dihydrofolate reductase (DHFR) Reduction in the ability of the drug to penetrate the bacterial cell wall Production of altered forms of the dihydropteroate synthetase (DPS) enzyme with a lower affinity for sulfonamides Hyperproduction of PABA, which overcomes the competitive substitution of the sulfonamides |
sul1 sul2 sul3 | P, C | (95–97) |
C, chromosomal DNA; P, plasmid; Tn, transposon.