Antibiotics and Antimicrobial Resistance

  1. Biochemical Mechanisms of Resistance
    1. Drug Inactivation Mechanisms
      1. Beta-lactamase Enzymes
        1. Ambler Classification System
          1. Class A beta-lactamases
            1. Class B metallo-beta-lactamases
              1. Class C AmpC enzymes
                1. Class D OXA enzymes
                2. Extended-Spectrum Beta-lactamases
                  1. TEM variants
                    1. SHV variants
                      1. CTX-M enzymes
                      2. Carbapenemase Enzymes
                        1. KPC enzymes
                          1. NDM enzymes
                            1. OXA-48 family
                          2. Aminoglycoside-Modifying Enzymes
                            1. Acetyltransferases
                              1. Phosphotransferases
                                1. Nucleotidyltransferases
                                2. Other Inactivating Enzymes
                                  1. Chloramphenicol acetyltransferases
                                    1. Macrolide esterases
                                  2. Target Site Modification
                                    1. Penicillin-Binding Protein Alterations
                                      1. Low-affinity PBPs
                                        1. Mosaic PBPs
                                          1. PBP overproduction
                                          2. Ribosomal Modifications
                                            1. 16S rRNA methylation
                                              1. 23S rRNA mutations
                                                1. Ribosomal protein changes
                                                2. DNA Gyrase Mutations
                                                  1. Quinolone resistance-determining regions
                                                    1. Topoisomerase IV mutations
                                                    2. RNA Polymerase Mutations
                                                      1. Rifampicin resistance mutations
                                                    3. Reduced Drug Accumulation
                                                      1. Decreased Permeability
                                                        1. Porin Channel Modifications
                                                          1. OmpF and OmpC changes
                                                            1. Porin loss
                                                              1. Selectivity alterations
                                                            2. Active Efflux Systems
                                                              1. Major Facilitator Superfamily
                                                                1. Single-drug efflux pumps
                                                                  1. Substrate specificity
                                                                  2. Resistance-Nodulation-Division Family
                                                                    1. Multidrug efflux systems
                                                                      1. Tripartite complexes
                                                                      2. ATP-Binding Cassette Transporters
                                                                        1. Energy-dependent efflux
                                                                        2. Small Multidrug Resistance Family
                                                                      3. Target Protection Mechanisms
                                                                        1. Ribosomal Protection Proteins
                                                                          1. Tet(M) family proteins
                                                                            1. Tet(O) mechanisms
                                                                            2. DNA Protection Mechanisms
                                                                            3. Metabolic Bypass Mechanisms
                                                                              1. Alternative Pathway Utilization
                                                                                1. Target Enzyme Overproduction
                                                                                  1. Precursor Modification

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                                                                                3. Understanding Antimicrobial Resistance

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                                                                                5. Drivers and Epidemiology of Antimicrobial Resistance