Cited by 1,082Antibiotic Resistance in BacteriaDrug Transport and Resistance MechanismsBacterial Genetics and Biotechnology

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Efflux-mediated antimicrobial resistance

Poole, Keith·2005·Journal of Antimicrobial Chemotherapy

DOI 10.1093/jac/dki171

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Abstract

Antibiotic resistance continues to plague antimicrobial chemotherapy of infectious disease. And while true biocide resistance is as yet unrealized, in vitro and in vivo episodes of reduced biocide susceptibility are common and the history of antibiotic resistance should not be ignored in the development and use of biocidal agents. Efflux mechanisms of resistance, both drug specific and multidrug, are important determinants of intrinsic and/or acquired resistance to these antimicrobials, with some accommodating both antibiotics and biocides. This latter raises the spectre (as yet generally unrealized) of biocide selection of multiple antibiotic-resistant organisms. Multidrug efflux mechanisms are broadly conserved in bacteria, are almost invariably chromosome-encoded and their expression in many instances results from mutations in regulatory genes. In contrast, drug-specific efflux mechanisms are generally encoded by plasmids and/or other mobile genetic elements (transposons, integrons) that carry additional resistance genes, and so their ready acquisition is compounded by their association with multidrug resistance. While there is some support for the latter efflux systems arising from efflux determinants of self-protection in antibiotic-producing Streptomyces spp. and, thus, intended as drug exporters, increasingly, chromosomal multidrug efflux determinants, at least in Gram-negative bacteria, appear not to be intended as drug exporters but as exporters with, perhaps, a variety of other roles in bacterial cells. Still, given the clinical significance of multidrug (and drug-specific) exporters, efflux must be considered in formulating strategies/approaches to treating drug-resistant infections, both in the development of new agents, for example, less impacted by efflux and in targeting efflux directly with efflux inhibitors.

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Authors: Poole, K.
Affiliations: Queen's University (CA)
Corresponding author: Poole, Keith
ORCID: Poole, Keith
Venue: Journal of Antimicrobial Chemotherapy
Publisher: Oxford University Press (OUP)
Published: 2005-05-24
Volume: 56
Issue: 1
Pages: 20-51
ISSN: 0305-7453 (ISSN-L)
1460-2091
DOI: 10.1093/jac/dki171
OpenAlex: W2131256712
Cited by: 1,082
References: 733
Citations by year: 2026: 37 · 2025: 50 · 2024: 54 · 2023: 54 · 2022: 43 · 2021: 63 · 2020: 57 · 2019: 52 · 2018: 48 · 2017: 52 · 2016: 70 · 2015: 52 · 2014: 61 · 2013: 57 · 2012: 54
FWCI: 2.24
Type: journal article
Language: en
Open access: closed
Locations: Journal of Antimicrobial Chemotherapy (publishedVersion)
PubMed (publishedVersion)
HighWire Press Open Archive (submittedVersion)
Topics: Health Sciences › Medicine › Microbiology (medical) › Antibiotic Resistance in Bacteria
Health Sciences › Medicine › Oncology › Drug Transport and Resistance Mechanisms
Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Bacterial Genetics and Biotechnology
Keywords: efflux-mediated resistance, antimicrobial resistance, multidrug efflux pumps, biocide resistance, multidrug resistance, plasmid-encoded resistance genes, integrons, transposable elements, mobile genetic elements, efflux pump inhibitors, Gram-negative bacteria, intrinsic resistance, acquired resistance
MeSH terms: Aminoglycosides, Anti-Bacterial Agents, Biological Transport, Chloramphenicol, Tetracycline, Fluoroquinolones, Drug Resistance, Bacterial, Drug Resistance, Multiple, Bacterial

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