XXXX : evolution of antimicrobial resistance-treatment options.

@entity1 @entity3273 @entity281 @entity2893 @entity3064 @entity9001 @entity68
The first decade of the 20th century witnessed a surge in the incidence of @entity281 due to several highly antimicrobial-resistant bacteria in hospitals worldwide. @entity3064 is one such organism that turned from an occasional respiratory pathogen into a major nosocomial pathogen. An increasing number of A. baumannii genome sequences have broadened our understanding of the genetic makeup of these bacteria and highlighted the extent of horizontal transfer of DNA. Animal models of disease combined with bacterial mutagenesis have provided some valuable insights into mechanisms of A. baumannii pathogenesis. Bacterial factors known to be important for disease include outer membrane porins, surface structures including capsule and lipopolysaccharide, enzymes such as phospholipase D, @entity68 acquisition systems, and regulatory proteins. A. baumannii has a propensity to accumulate resistance to various groups of antimicrobial agents. In particular, @entity2893 resistance has become commonplace, accounting for the majority of A. baumannii strains in many hospitals today. @entity2893 -resistant strains are often resistant to all other routinely tested agents. Treatment of @entity2893 -resistant A. baumannii @entity281 therefore involves the use of combinations of last resort agents such as @entity3273 and @entity9001 , but the efficacy and safety of these approaches are yet to be defined. Antimicrobial-resistant A. baumannii has high potential to spread among ill @entity1 in intensive care units. Early recognition and timely implementation of appropriate @entity281 control measures is crucial in preventing outbreaks.
