The burden of hospital acquired infections and antimicrobial resistance

Molly Kukua Abban; Eunice Ampadubea Ayerakwa; Lydia Mosi; Abiola Isawumi

doi:10.1016/j.heliyon.2023.e20561

The burden of hospital acquired infections and antimicrobial resistance

Heliyon. 2023 Oct 2;9(10):e20561. doi: 10.1016/j.heliyon.2023.e20561. eCollection 2023 Oct.

Authors

Molly Kukua Abban^{1

2}, Eunice Ampadubea Ayerakwa^{1

2}, Lydia Mosi^{1

2}, Abiola Isawumi^{1

2}

Affiliations

¹ West African Centre for Cell Biology of Infectious Pathogens, P.O. Box LG 54, Volta Road, University of Ghana, Legon, Accra, Ghana.
² Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, P.O. Box LG 54, Volta Road, University of Ghana, Legon, Accra, Ghana.

Abstract

The burden of Hospital care-associated infections (HCAIs) is becoming a global concern. This is compounded by the emergence of virulent and high-risk bacterial strains such as "ESKAPE" pathogens - (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species), especially within Intensive care units (ICUs) that house high-risk and immunocompromised patients. In this review, we discuss the contributions of AMR pathogens to the increasing burden of HCAIs and provide insights into AMR mechanisms, with a particular focus on last-resort antibiotics like polymyxins. We extensively discuss how structural modifications of surface-membrane lipopolysaccharides and cationic interactions influence and inform AMR, and subsequent severity of HCAIs. We highlight some bacterial phenotypic survival mechanisms against polymyxins. Lastly, we discuss the emergence of plasmid-mediated resistance as a phenomenon making mitigation of AMR difficult, especially within the ICUs. This review provides a balanced perspective on the burden of HCAIs, associated pathogens, implication of AMR and factors influencing emerging AMR mechanisms.

Keywords: AMR mechanisms; Antimicrobial resistance; ESKAPE pathogens; Hospital care-associated infections; Nosocomial infections; Polymyxins.

Publication types

Review