Multi-Pathogen Aminoglycoside Resistance: A Dual Approach in Investigating Bacteria Across Various Clinical Infections
DOI:
https://doi.org/10.31580/pjmls.v7i3.3147Keywords:
Aminoglycoside resistance, multi-pathogen, E. coli, K. pneumoniae, P. aeruginosa, clinical infections, resistance mechanisms, combination therapy.Abstract
Aminoglycosides are vital antibiotics for treating severe Gram-negative bacterial infections, but the evolution of resistance mechanisms creates huge treatment hurdles. This work reviews resistance mechanisms to aminoglycosides such as AMEs, efflux pumps, ribosomal mutations and enzymatic modifications across several pathogens: It also examines the clinical significance of the resistance in different contexts of infection. A contextual and comparative case study investigated genetic and phenotypic resistance to aminoglycosides. A systematic review using PRISMA standards examined clinical trials published between 2010 and 2023 on PubMed and ClinicalTrials.gov. Inclusion criteria for 100 papers on aminoglycoside-resistant Gram-negative infections (Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa) were studies that described mechanisms of aminoglycoside resistance as well as clinical outcomes. Exclusion criteria eliminated research that lacked significant data on pathogen resistance. I2 statistical method used a meta-analytic approach. Finally, 40 articles were reviewed for resistance mechanisms and cross-resistance to other antibiotics. 12 studies were included in the table. AMEs were the most prevalent mechanism of resistance, especially in E. coli and K. pneumoniae. AMEs were also implicated in treatment failures and post-therapy relapses. Among the antibiotics tested, aminoglycoside concentrations were significantly lower in K. pneumoniae and P. aeruginosa, and this decrease was associated with efflux pump overexpression in both bacteria, providing cross-resistance with β-lactams and fluoroquinolones. Hence these mutations are associated with extended hospital stays and poor outcomes in patients. Substantial cross-resistance rates add to the complexity of management interventions. Resistance of multiple pathogenic organisms to the aminoglycoside class of antibiotics remains a major obstacle in clinical infection practice. These results highlight the importance of regular genotypic surveillance of resistance patterns and the necessity of discovering specific drugs for mechanisms such as AME inhibitors or efflux pump inhibitors. Precise treatment protocols drawn from pathogen-specific resistance mechanisms could enhance clinical efficacy while reducing the transmission of MDR pathogens.
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