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Adv Drug Deliv Rev. 2014 Nov 30;78:3-13. doi: 10.1016/j.addr.2014.08.003. Epub 2014 Aug 16.

Mechanisms of β-lactam antimicrobial resistance and epidemiology of major community- and healthcare-associated multidrug-resistant bacteria.

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Singapore General Hospital, Outram Road, Singapore 169608, Singapore. Electronic address:
Thammasat University Hospital, Pathumthani 12120, Thailand. Electronic address:
National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228, Singapore. Electronic address:


Alexander Fleming's discovery of penicillin heralded an age of antibiotic development and healthcare advances that are premised on the ability to prevent and treat bacterial infections both safely and effectively. The resultant evolution of antimicrobial resistant mechanisms and spread of bacteria bearing these genetic determinants of resistance are acknowledged to be one of the major public health challenges globally, and threatens to unravel the gains of the past decades. We describe the major mechanisms of resistance to β-lactam antibiotics - the most widely used and effective antibiotics currently - in both Gram-positive and Gram-negative bacteria, and also briefly detail the existing and emergent pharmacological strategies to overcome such resistance. The global epidemiology of the four major types of bacteria that are responsible for the bulk of antimicrobial-resistant infections in the healthcare setting - methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Enterobactericeae, and Acinetobacter baumannii - are also briefly described.


Acinetobacter baumannii; Antimicrobial resistance; Carbapenem resistance; Enterobacteriaceae; Methicillin-resistant Staphylococcus aureus; Vancomycin-resistant enterococci; β-Lactamases

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