ESKAPE biofilms: challenges and solutions

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About this Research Topic

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Background

ESKAPE bacteria (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) are listed as the antibiotic-resistant priority pathogens in the WHO list (2022). Enterococcus faecium, one of the most common causes of nosocomial infection associated with the use of indwelling medical devices is resistant to glycopeptides, beta-lactams, aminoglycoside and macrolides. Staphylococcus aureus has rapidly developed and acquire antibiotic resistance that has led to the emergence of multidrug-resistant strains such as methicillin-resistant and vancomycin-resistant S. aureus. The emergence of antibiotic-resistant strains of K. pneumoniae worldwide has become a cause of concern where extended-spectrum β-lactamases (ESBLs) and carbapenemase-producing strains have been isolated with increasing frequency. A. baumannii has become resistant to almost all commonly used antimicrobial agents, including aminoglycosides, quinolones and broad-spectrum β-lactams, and multidrug or pan-drug-resistant strains are becoming a frequent problem in the clinical setting. Pseudomonas aeruginosa displays resistance to aminoglycosides, quinolones and β-lactams via various mechanisms such as low outer membrane permeability, expression of efflux pumps that expel antibiotics out of the cell and the production of antibiotic-inactivating enzymes. The unique ability of Enterobacter species in acquiring genes that encode resistance to multiple classes of antibiotics, including the carbapenems, has contributed to the increasing spread of carbapenem-resistant infections in the clinical setting.

These pathogens also form biofilms that allows further protection from the current antibiotics which are developed to treat infections involving planktonic bacterial populations in acute infections. Various alternative therapies such as use of antibiotics in combination or with adjuvants, antimicrobial peptides, phytochemicals, nanoparticles, and photodynamic light therapy have been widely reported.

The aim of this research topic is to describe these alternative therapies in the treatment of ESKAPE infections, advantages and limitations, potential application, and status in clinical trials.

This issue covers original research, review, short communication and commentary in the area of challenges and the strategies involved in the removal of biofilms formed by the ESKAPE pathogens to improve clinical outcomes in chronic infections.

Keywords: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species, multidrug-resistant, biofilms

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